Provider Demographics
NPI:1154378578
Name:MORET, ANN (RN MSN C-CNS)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:MORET
Suffix:
Gender:F
Credentials:RN MSN C-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-450-5094
Mailing Address - Fax:708-344-0508
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:STE 210
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-5094
Practice Address - Fax:708-344-0508
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003424364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209712OtherMEDICARE GROUP NUMBER
IL1164530713OtherNPI GROUP NUMBER FOR CONSULTANTS IN CARDIOVASCULAR MEDICINE, S.C.
IL31602469OtherBLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER
ILCC1592OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILK11962OtherMEDICARE INDIVIDUAL PROVIDER NUMBER
IL961280OtherMEDICARE GROUP PTAN NUMBER
ILP00168872OtherRAILROAD MEDICARE PROVIDER ID NUMBER
IL209712OtherMEDICARE GROUP NUMBER