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NPI Code Detail

MEDICARE: LAVERNE BALOGUN-MOORE

MEDICARE: LAVERNE BALOGUN-MOORE
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
1164W00000XLicensed Practical NursePN270966PA

General Provider Information

NPI Number : 1851413132
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAVERNE BALOGUN-MOORE
Provider Business Mailing Address
First Line : 5535 BALTIMORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19143-2841
Country : US
Telephone Number : 215-476-5453
Fax Number :
Provider Business Practice Location Address
First Line : 2250 HICKORY RD
Second Line : SUITE 240
City : PLYMOUTH MEETING
State : PA
Zip : 19462-1047
Country : US
Telephone Number : 610-834-1122
Fax Number : 610-834-7525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 07/08/2007

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Directions to “ LAVERNE BALOGUN-MOORE ” Practice Location

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