Provider Demographics
NPI:1932420726
Name:MOOREHOUSE, LAURIE (LMT, RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MOOREHOUSE
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 HAZARD RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9745
Mailing Address - Country:US
Mailing Address - Phone:315-536-4564
Mailing Address - Fax:
Practice Address - Street 1:2336 HAZARD RD
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-9745
Practice Address - Country:US
Practice Address - Phone:315-536-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY408654163W00000X
NY026754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse