Individual provider · Type 1 NPI

Havona Moore

Licensed Practical Nurse · Maplewood, MN

NPI number 1174475040 Active

Practice location

3100 Kennard St
Maplewood, MN 55109-5465

Call (651) 225-5456 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000XL-625029 (MN)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1174475040

Havona Moore's National Provider Identifier is 1174475040, issued on Feb 12, 2026. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Maplewood, MN. The record was last updated on Feb 12, 2026.