Provider Demographics
NPI:1558021774
Name:MORENO, STEPHANIE (CNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NC 54 APT D1
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2145
Mailing Address - Country:US
Mailing Address - Phone:980-293-2565
Mailing Address - Fax:
Practice Address - Street 1:401 NC 54 APT D1
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2145
Practice Address - Country:US
Practice Address - Phone:980-293-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC533032376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC533032OtherNORTH CAROLINA NURSE AID I REGISTRY