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General NPI Number Information
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NPI Number | 1558824078
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Entity Type | Individual
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Provider Name | LAURA MARIE MOFFAT MSN, RN, AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5165 MCCARTY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-8764
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Country | US
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Telephone | 765-838-6378
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Fax |
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Provider Business Mailing Address
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Address Line | 2303 SYCAMORE LN
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1927
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Country | US
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Telephone | 765-607-1967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 28200708
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License Number State | IN
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