MEDICARE: MRS. JUDITH ANNE MORAN C.R.N.A.

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	367500000X	Certified Registered Nurse Anesthetist	C01016	AR
2	367500000X	Certified Registered Nurse Anesthetist	APN0000010072	TN
3	367500000X	Certified Registered Nurse Anesthetist	128948	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	900418777	OTHER	MO	RR MEDICARE

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
2	4068895	OTHER	TN	BLUE CROSS TN PROV #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	5T743	OTHER	AR	BLUE CROSS AR PROV #

General Provider Information

NPI Number	:	1710971908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH ANNE MORAN C.R.N.A.

Provider Business Mailing Address
First Line	:	PO BOX 22407
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-0407
Country	:	US
Telephone Number	:	636-386-7222
Fax Number	:	636-386-7810

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	636-386-7222
Fax Number	:	636-386-7810

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	02/12/2016

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Directions to “ MRS. JUDITH ANNE MORAN C.R.N.A.” Practice Location

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