Provider Demographics
NPI:1346307659
Name:MOORE, LONDA (CAREGIVER)
Entity Type:Individual
Prefix:MS
First Name:LONDA
Middle Name:
Last Name:MOORE
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 1:2209 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-6551
Mailing Address - Country:US
Mailing Address - Phone:775-220-2091
Mailing Address - Fax:
Practice Address - Street 1:1923 APACHE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4821
Practice Address - Country:US
Practice Address - Phone:530-573-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider