MEDICARE: TINA MOREY 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	164196-30	WI

General Provider Information

NPI Number	:	1487077061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA MOREY RN

Provider Business Mailing Address
First Line	:	430 N WEBSTER AVE
Second Line	:
City	:	OMRO
State	:	WI
Zip	:	54963-1032
Country	:	US
Telephone Number	:	920-216-4879
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 N WEBSTER AVE
Second Line	:
City	:	OMRO
State	:	WI
Zip	:	54963-1032
Country	:	US
Telephone Number	:	920-216-4879
Fax Number	:

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

Provider Enumeration Date	:	02/01/2014
Last Update Date	:	02/01/2014

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