Individual
BREA SHANICE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14150 GRAND SETTLEMENT BLVD, BATON ROUGE, LA 70818-4326
(225) 270-9263
Mailing address
14150 GRAND SETTLEMENT BLVD, BATON ROUGE, LA 70818-4326
(225) 270-9263
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
LA
Enumeration date
01/08/2021
Last updated
01/08/2021
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