Provider Demographics
NPI:1609350032
Name:MORENO, MARIA J (APN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:MORENO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 W WILSON ST STE E
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-7693
Mailing Address - Country:US
Mailing Address - Phone:630-879-5700
Mailing Address - Fax:630-879-6457
Practice Address - Street 1:1180 W WILSON ST STE E
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-7693
Practice Address - Country:US
Practice Address - Phone:630-879-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner