Individual
LAVONNE M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC CNM
Contact information
Practice address
1313 PENN AVENUE NORTH, MINNEAPOLIS, MN 55441
(612) 543-2500
(612) 302-4870
Mailing address
1313 PENN AVENUE NORTH, MINNEAPOLIS, MN 55441
(612) 543-2500
(612) 302-4870
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R1138272
MN
367A00000X
Advanced Practice Midwife
R113827-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
702615300
—
MN
Enumeration date
04/27/2006
Last updated
02/26/2013
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