Provider Demographics
NPI:1407876873
Name:MORENO-CHRISTIANSEN, SANDRA (BSN, WHNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:MORENO-CHRISTIANSEN
Suffix:
Gender:F
Credentials:BSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HURON TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6708
Mailing Address - Country:US
Mailing Address - Phone:972-841-2104
Mailing Address - Fax:
Practice Address - Street 1:3320 LIVE OAK ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6109
Practice Address - Country:US
Practice Address - Phone:214-266-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244159363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139696218Medicaid
TX244159OtherSTATE LICENSE
TX10007060OtherAMERIGROUP ID #
TX89N734OtherBLUE CROSS &BLUE SHIELD
TX244159OtherSTATE LICENSE
TX139696218Medicaid