Healthcare Provider Details

I. General information

NPI: 1508664848
Provider Name (Legal Business Name): MORAYA BUENANO CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8617 EDINBROOK XING APT 307
BROOKLYN PARK MN
55443-4005
US

IV. Provider business mailing address

8617 EDINBROOK XING APT 307
BROOKLYN PARK MN
55443-4005
US

V. Phone/Fax

Practice location:
  • Phone: 612-494-1718
  • Fax:
Mailing address:
  • Phone: 612-494-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: