Healthcare Provider Details

I. General information

NPI: 1427318518
Provider Name (Legal Business Name): NICOLE ASHLEY MORETTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 MEDICAL ARTS ST STE 2
AUSTIN TX
78705-3331
US

IV. Provider business mailing address

2911 MEDICAL ARTS ST STE 2
AUSTIN TX
78705-3331
US

V. Phone/Fax

Practice location:
  • Phone: 512-391-0175
  • Fax: 512-476-4078
Mailing address:
  • Phone: 512-391-0175
  • Fax: 512-476-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR4878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: