Individual
LAURA MARIE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
5603 CAMINO REALE, MIDLAND, TX 79707-2124
(432) 803-2714
Mailing address
4400 ANDREWS HWY APT 502, MIDLAND, TX 79703-4727
(432) 803-2714
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
331519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40413944
DRIVERS LICENSE
TX
Enumeration date
02/21/2018
Last updated
02/21/2018
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