Healthcare Provider Details

I. General information

NPI: 1477463461
Provider Name (Legal Business Name): GERHA MAE MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 N GREEN VALLEY PKWY
HENDERSON NV
89014-5024
US

IV. Provider business mailing address

10355 FANCY FERN ST
LAS VEGAS NV
89183-5209
US

V. Phone/Fax

Practice location:
  • Phone: 702-766-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number837555
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: