Provider Demographics
NPI:1356080758
Name:MORAN, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10875 W ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5479
Mailing Address - Country:US
Mailing Address - Phone:623-882-6238
Mailing Address - Fax:
Practice Address - Street 1:501 W VAN BUREN ST STE T
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1307
Practice Address - Country:US
Practice Address - Phone:623-932-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily