Healthcare Provider Details

I. General information

NPI: 1184105181
Provider Name (Legal Business Name): ELIZABETH MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 METPARK DR
LAS VEGAS NV
89110-3522
US

IV. Provider business mailing address

6128 W SAHARA AVE
LAS VEGAS NV
89146-3051
US

V. Phone/Fax

Practice location:
  • Phone: 702-498-5858
  • Fax:
Mailing address:
  • Phone: 702-598-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number000000000
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: