MEDICARE: MARIE CARMEL MORENCY NURSE SPECIALIST

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	371114-1	NY

General Provider Information

NPI Number	:	1871643577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE CARMEL MORENCY NURSE SPECIALIST

Provider Business Mailing Address
First Line	:	6911 ELLIS CT APT A
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-3124
Country	:	US
Telephone Number	:	337-531-0168
Fax Number	:	337-531-3175

Provider Business Practice Location Address
First Line	:	6911 ELLIS CT APT A
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-3124
Country	:	US
Telephone Number	:	337-531-0168
Fax Number	:	337-531-3175

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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