Provider Demographics
NPI:1992342729
Name:MORETA, ASHLEY MARIE (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:MORETA
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 1:414 WOODWARD AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1558
Mailing Address - Country:US
Mailing Address - Phone:646-552-4323
Mailing Address - Fax:
Practice Address - Street 1:414 WOODWARD AVE APT 3L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1558
Practice Address - Country:US
Practice Address - Phone:646-552-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760559-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse