Provider Demographics
NPI:1922509371
Name:MORENO, LAURA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:MORENO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 ANDREWS HWY APT 502
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4727
Mailing Address - Country:US
Mailing Address - Phone:432-803-2714
Mailing Address - Fax:
Practice Address - Street 1:5603 CAMINO REALE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2124
Practice Address - Country:US
Practice Address - Phone:432-803-2714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331519164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40413944OtherDRIVERS LICENSE