Provider Demographics
NPI:1588467716
Name:MOORE, LATORIA M
Entity type:Individual
Prefix:
First Name:LATORIA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LATORIA
Other - Middle Name:M
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13310 S 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2269
Mailing Address - Country:US
Mailing Address - Phone:910-340-0487
Mailing Address - Fax:
Practice Address - Street 1:13310 S 35TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2269
Practice Address - Country:US
Practice Address - Phone:910-340-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant