Most Relevant Information
Provider Data
| NPI Number: | 1003066259 |
| Provider Name: | LAURA DIANE MOON |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 55025 |
Most Important Dates
| Enumeration Date: | 09/24/2008 |
| Last Updated: | 03/15/2024 |
Provider Practice Location
1325 SPRING ST
GREENWOOD
SC
296463860
Practice Location Phone/Fax
| Phone: | 8647254111 |
| Fax: |
Provider Mailing Location
110 ROANE ST
CHARLESTON
WV
253022334
Provider Mailing Phone/Fax
| Phone: | 3043440096 |
| Fax: | 3043424725 |