Healthcare Provider Details

I. General information

NPI: 1639673262
Provider Name (Legal Business Name): LAURIE MORENO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PENFIELD AVE
AKRON OH
44310-2912
US

IV. Provider business mailing address

340 S BROADWAY ST
AKRON OH
44308-1529
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.397995
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0037716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: