Individual
LAURA DIANE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 SPRING ST, GREENWOOD, SC 29646-3860
(864) 725-4111
Mailing address
110 ROANE ST, CHARLESTON, WV 25302-2334
(304) 344-0096
(304) 342-4725
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
55025
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
26055
SC
367500000X
Certified Registered Nurse Anesthetist
79610
WV
Other
Enumeration date
09/24/2008
Last updated
03/15/2024
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