| NPI | 1023715588 |
|---|---|
| Former Name | LAKISHA YVETTE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 272273) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2024-02-22 |