Provider Demographics
NPI:1225248347
Name:MORETON, DANIE ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:DANIE
Middle Name:ANN
Last Name:MORETON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DANIE
Other - Middle Name:ANN
Other - Last Name:MORETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:190 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1966
Mailing Address - Country:US
Mailing Address - Phone:716-310-5740
Mailing Address - Fax:
Practice Address - Street 1:190 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1966
Practice Address - Country:US
Practice Address - Phone:716-310-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223071-1164W00000X
NY846209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155044Medicaid