Healthcare Provider Details

I. General information

NPI: 1205757267
Provider Name (Legal Business Name): KARINNA RAE MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GARFIELD ST APT C
LINCOLN NE
68502-2464
US

IV. Provider business mailing address

1400 GARFIELD ST APT C
LINCOLN NE
68502-2464
US

V. Phone/Fax

Practice location:
  • Phone: 402-450-8940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: