Provider Demographics
NPI:1548049653
Name:MOORE, TONYA LAVETTE (BIRTH DOULA)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LAVETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W 4TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1041
Mailing Address - Country:US
Mailing Address - Phone:563-210-6512
Mailing Address - Fax:
Practice Address - Street 1:625 W 4TH ST APT 103
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1041
Practice Address - Country:US
Practice Address - Phone:563-210-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula