Provider Demographics
NPI:1588395297
Name:MOORE, LATASHA D
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:D
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 1:1609 CITY PARK AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2252
Mailing Address - Country:US
Mailing Address - Phone:757-609-1359
Mailing Address - Fax:
Practice Address - Street 1:1609 CITY PARK AVE APT 7
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2252
Practice Address - Country:US
Practice Address - Phone:757-609-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula