MEDICARE: DR. NICOLE E MORET NP

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	363L00000X	Nurse Practitioner	0024165787	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024165787	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609966555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE E MORET NP

Provider Business Mailing Address
First Line	:	5980 9TH ST
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5509
Country	:	US
Telephone Number	:	505-272-1991
Fax Number	:	505-272-2016

Provider Business Practice Location Address
First Line	:	5980 9TH ST
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5509
Country	:	US
Telephone Number	:	505-272-1991
Fax Number	:	505-272-2016

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/07/2015

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