Provider Demographics
NPI:1467882100
Name:MORENO, MARION LOUISE (APNP)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:LOUISE
Last Name:MORENO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N RICHMOND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1956
Mailing Address - Country:US
Mailing Address - Phone:920-997-0511
Mailing Address - Fax:
Practice Address - Street 1:2600 N RICHMOND ST
Practice Address - Street 2:SUITE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1956
Practice Address - Country:US
Practice Address - Phone:920-997-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5575-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily