Provider Demographics
NPI:1508153388
Name:MOORE, KATRINA VERATTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:VERATTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:VERATTE
Other - Last Name:PEEBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 LEGARE ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1824
Mailing Address - Country:US
Mailing Address - Phone:843-752-7479
Mailing Address - Fax:
Practice Address - Street 1:215 LEGARE ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1824
Practice Address - Country:US
Practice Address - Phone:843-752-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse