Provider Demographics
NPI:1639940133
Name:MOORE, TANISHA (PHLEBOTOMY TECH)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MAGNOLIA GARDENS ST # 134B
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-5529
Mailing Address - Country:US
Mailing Address - Phone:225-529-4037
Mailing Address - Fax:
Practice Address - Street 1:2415 MAGNOLIA GARDENS ST # 134B
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-5529
Practice Address - Country:US
Practice Address - Phone:225-529-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy