Healthcare Provider Details

I. General information

NPI: 1508153388
Provider Name (Legal Business Name): KATRINA VERATTE MOORE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KATRINA VERATTE PEEBLES

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LEGARE ST
LATTA SC
29565-1824
US

IV. Provider business mailing address

215 LEGARE ST
LATTA SC
29565-1824
US

V. Phone/Fax

Practice location:
  • Phone: 843-752-7479
  • Fax:
Mailing address:
  • Phone: 843-752-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: