Provider Demographics
NPI:1407134083
Name:MORELAND, JEANINE MARIE
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:MARIE
Last Name:MORELAND
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 1:2030 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4013
Mailing Address - Country:US
Mailing Address - Phone:775-200-4030
Mailing Address - Fax:888-331-0717
Practice Address - Street 1:2030 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4013
Practice Address - Country:US
Practice Address - Phone:775-200-4030
Practice Address - Fax:888-331-0717
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner