Healthcare Provider Details

I. General information

NPI: 1154378578
Provider Name (Legal Business Name): ANN MORET R.N. MSN C-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 210
MELROSE PARK IL
60160-1634
US

IV. Provider business mailing address

675 W NORTH AVE STE 210
MELROSE PARK IL
60160-1634
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-5094
  • Fax: 708-344-0508
Mailing address:
  • Phone: 708-450-5094
  • Fax: 708-344-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209003424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: