MEDICARE: MRS. LAWANA DEMETRIA MORELAND CNA/CMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	CNANA0008773825	TX

General Provider Information

NPI Number	:	1538717152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAWANA DEMETRIA MORELAND CNA/CMA

Provider Business Mailing Address
First Line	:	4700 WIMBELTON WAY
Second Line	:	APT. 513
City	:	DALLAS
State	:	TX
Zip	:	75227-2523
Country	:	US
Telephone Number	:	469-531-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 WIMBELTON WAY
Second Line	:	APT. 513
City	:	DALLAS
State	:	TX
Zip	:	75227-2523
Country	:	US
Telephone Number	:	469-531-8413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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