Individual
LAVERNE BALOGUN-MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
(610) 834-7525
Mailing address
5535 BALTIMORE AVE, PHILADELPHIA, PA 19143-2841
(215) 476-5453
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN270966
PA
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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