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General NPI Number Information
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NPI Number | 1982219697
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Entity Type | Individual
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Provider Name | LAURA MORENO APRN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 1534 E. 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3630
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Country | US
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Telephone | 405-861-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 1632 CAMDEN WAY # X
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City | EDMOND
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State | OK
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Zip | 73013-2939
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Country | US
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Telephone | 405-926-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 115206
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200085
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License Number State | OK
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