Provider Demographics
NPI:1437122199
Name:MOREHOUSE, ROBERTA KURNER (CPNP)
Entity Type:Individual
Prefix:PROF
First Name:ROBERTA
Middle Name:KURNER
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 N MCQUEEN RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8145
Mailing Address - Country:US
Mailing Address - Phone:480-222-8080
Mailing Address - Fax:480-222-3574
Practice Address - Street 1:961 N MCQUEEN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8145
Practice Address - Country:US
Practice Address - Phone:480-222-8080
Practice Address - Fax:480-222-3574
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN034990363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ532392Medicaid