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NPI Code Detail

MEDICARE: LAURENT AIESHA MOE CRNA

MEDICARE: LAURENT AIESHA MOE CRNA
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
1367500000XCertified Registered Nurse AnesthetistRN623066PA
2367500000XCertified Registered Nurse Anesthetist117157NC

General Provider Information

NPI Number : 1043749773
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURENT AIESHA MOE CRNA
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-707-3326
Fax Number : 215-707-8028
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 215-707-3326
Fax Number : 215-707-8028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2017
Last Update Date : 03/24/2026

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Directions to “ LAURENT AIESHA MOE CRNA” Practice Location

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