Provider Demographics
NPI:1720644073
Name:MORENO, CAROL NEFF (RN, MSN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:NEFF
Last Name:MORENO
Suffix:
Gender:F
Credentials:RN, MSN
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Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-477-5114
Mailing Address - Fax:253-477-5140
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5195
Practice Address - Country:US
Practice Address - Phone:253-477-5114
Practice Address - Fax:253-477-5140
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX244627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2-44627OtherRN