Healthcare Provider Details

I. General information

NPI: 1639739212
Provider Name (Legal Business Name): LAURA MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 WOODLEY RD STE 300
TOLEDO OH
43606-1100
US

IV. Provider business mailing address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-4449
  • Fax:
Mailing address:
  • Phone: 419-725-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.448357
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.024972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: