Provider Demographics
NPI:1891858361
Name:MOORE, LASHANNE E
Entity Type:Individual
Prefix:
First Name:LASHANNE
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MELBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3245
Mailing Address - Country:US
Mailing Address - Phone:864-285-0786
Mailing Address - Fax:
Practice Address - Street 1:417 MELBOURNE LN
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3245
Practice Address - Country:US
Practice Address - Phone:864-285-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator