Healthcare Provider Details

I. General information

NPI: 1396098562
Provider Name (Legal Business Name): EMILY RENEE MORENO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY RENEE CUSICK NP

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9399 CROWN CREST BLVD STE 240
PARKER CO
80138-8571
US

IV. Provider business mailing address

9399 CROWN CREST BLVD STE 240
PARKER CO
80138-8571
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-1310
  • Fax: 720-452-2082
Mailing address:
  • Phone: 720-330-1310
  • Fax: 720-452-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number599565
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.997112-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1678229
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0997112-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22468
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0997112-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: