Provider Demographics
NPI:1306176003
Name:MORENO, DEBRA JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:MORENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-9604
Mailing Address - Country:US
Mailing Address - Phone:631-929-6890
Mailing Address - Fax:
Practice Address - Street 1:126 E WOODLAND DR
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-9604
Practice Address - Country:US
Practice Address - Phone:631-929-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619055163WC3500X, 163WG0600X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WG0600XNursing Service ProvidersRegistered NurseGerontology