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Individual

MRS. LAURA ANN MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPA-C

Contact information

Practice address
3669 COUNTRYSIDE LN, MARION, NY 14505-9781
(315) 926-7733
(315) 926-0731
Mailing address
3669 COUNTRYSIDE LN, MARION, NY 14505-9781
(315) 926-7733
(315) 926-0731

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
003362 1
NY
363AM0700X
Medical Physician Assistant
Primary
003362
NY
363AM0700X
Medical Physician Assistant
3362
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01293301
NY
01
P019003362
BLUE CHOICE
NY
01
PA0030
PREFERRED CARE
NY
Enumeration date
07/28/2006
Last updated
06/29/2023
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