MEDICARE: LAURA 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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN.448357	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.024972	OH

General Provider Information

NPI Number	:	1639739212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MOORE RN

Provider Business Mailing Address
First Line	:	3909 WOODLEY RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1169
Country	:	US
Telephone Number	:	419-725-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 WOODLEY RD STE 300
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1100
Country	:	US
Telephone Number	:	419-475-4449
Fax Number	:

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	05/04/2026

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