Provider Demographics
NPI:1508838780
Name:MOORE-DUNCAN, LANNA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LANNA
Middle Name:MERCEDES
Last Name:MOORE-DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 S 224TH ST
Mailing Address - Street 2:APARTMENT 104
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6643
Mailing Address - Country:US
Mailing Address - Phone:206-653-7215
Mailing Address - Fax:
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-582-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA604782084P0800X
WAMD00046495101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ615418Medicare ID - Type Unspecified
NJG12134Medicare UPIN