Provider Demographics
NPI:1538717152
Name:MORELAND, LAWANA DEMETRIA (CNA/CMA)
Entity type:Individual
Prefix:MRS
First Name:LAWANA
Middle Name:DEMETRIA
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CNA/CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WIMBELTON WAY
Mailing Address - Street 2:APT. 513
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-2523
Mailing Address - Country:US
Mailing Address - Phone:469-531-8413
Mailing Address - Fax:
Practice Address - Street 1:4700 WIMBELTON WAY
Practice Address - Street 2:APT. 513
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2523
Practice Address - Country:US
Practice Address - Phone:469-531-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCNANA00087738253747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider