NPI Profile for RAVEN O MOORE in MANDEVILLE, LA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Diabetes Educator |
163WD0400X |
| NPI # | 1073296257 |
|
| Status | Active | |
| Credentials | MSN, RN | |
| Entity | Individual | |
| Enumeration date | 08/14/2023 | |
| Last updated | 01/27/2024 - About 2 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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RAVEN O MOORE
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