MEDICARE: LAURYN MOORE RN

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
1	163W00000X	Registered Nurse	247920	SC

General Provider Information

NPI Number	:	1255896874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURYN MOORE RN

Provider Business Mailing Address
First Line	:	12330 METRIC BLVD APT 1113
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2525
Country	:	US
Telephone Number	:	864-567-5840
Fax Number	:

Provider Business Practice Location Address
First Line	:	12330 METRIC BLVD APT 1113
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2525
Country	:	US
Telephone Number	:	864-567-5840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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