Provider Demographics
NPI:1528784014
Name:MOORE, LAUREN A
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 CONSTITUTION AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5994
Mailing Address - Country:US
Mailing Address - Phone:818-300-7616
Mailing Address - Fax:
Practice Address - Street 1:501 ISLINGTON ST STE 2B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4288
Practice Address - Country:US
Practice Address - Phone:603-610-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0069175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath