Provider Demographics
NPI:1326936642
Name:MORENO, AMIA MELIS
Entity type:Individual
Prefix:
First Name:AMIA
Middle Name:MELIS
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-1010
Mailing Address - Country:US
Mailing Address - Phone:308-672-6269
Mailing Address - Fax:
Practice Address - Street 1:611 AVENUE A
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NE
Practice Address - Zip Code:69334-1010
Practice Address - Country:US
Practice Address - Phone:308-279-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE166652376K00000X, 374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide