Individual
MRS. LAVON RENA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
7400 MERTON MINTER ST, SAN ANTONIO, TX 78229-4404
(210) 617-5300
Mailing address
5455 ROWLEY RD UNIT 5103, SAN ANTONIO, TX 78240-4825
(216) 816-7754
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-121466
OH
164X00000X
Licensed Vocational Nurse
PN-121466
OH
164X00000X
Licensed Vocational Nurse
PN121466
OH
Other
Enumeration date
09/15/2010
Last updated
02/25/2026
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