Provider Demographics
NPI:1437036506
Name:MOORE, LANETTE
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:
Last Name:MOORE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15418 WEIR ST # 317
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5045
Mailing Address - Country:US
Mailing Address - Phone:402-305-1817
Mailing Address - Fax:
Practice Address - Street 1:11306 BIRCH PLZ APT 7
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2744
Practice Address - Country:US
Practice Address - Phone:402-614-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist