MEDICARE: MR. IKAIKA K MORENO FNP-BC

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	163WE0003X	Emergency Registered Nurse	RN80851	HI
2	363LF0000X	Family Nurse Practitioner	APRN-2456	HI
3	363LF0000X	Family Nurse Practitioner	812685	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	812685	OTHER	NV	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407349715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IKAIKA K MORENO FNP-BC

Provider Business Mailing Address
First Line	:	7220 S CIMARRON RD STE 155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2170
Country	:	US
Telephone Number	:	725-252-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 S CIMARRON RD STE 155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2170
Country	:	US
Telephone Number	:	725-252-8089
Fax Number	:	800-532-0674

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	03/19/2024

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Directions to “ MR. IKAIKA K MORENO FNP-BC” Practice Location

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