MEDICARE: HEATHER ANN MORENO

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	826218	AZ

General Provider Information

NPI Number	:	1922697093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ANN MORENO

Provider Business Mailing Address
First Line	:	4518 N 84TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-1552
Country	:	US
Telephone Number	:	210-912-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6523
Country	:	US
Telephone Number	:	480-747-7393
Fax Number	:

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “ HEATHER ANN MORENO ” Practice Location

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