MEDICARE: NORMA MOREIRA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	613137	NY

General Provider Information

NPI Number	:	1346619913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA MOREIRA RN

Provider Business Mailing Address
First Line	:	1477 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1906
Country	:	US
Telephone Number	:	718-979-6900
Fax Number	:	718-979-6940

Provider Business Practice Location Address
First Line	:	185 GARFIELD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3759
Country	:	US
Telephone Number	:	347-604-0158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	09/24/2015

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