Provider Demographics
NPI:1245603752
Name:MORELAND, LAVERNE GIDGET (CAREGIVER)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:GIDGET
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32303 PINTAIL STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423
Mailing Address - Country:US
Mailing Address - Phone:832-692-9461
Mailing Address - Fax:
Practice Address - Street 1:32303 PINTAIL STREET
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423
Practice Address - Country:US
Practice Address - Phone:281-375-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV74-3032742171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator