Provider Demographics
NPI:1609966555
Name:MORET, NICOLE E (NP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:E
Last Name:MORET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:E
Other - Last Name:MORET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC, CNS-BC
Mailing Address - Street 1:5980 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5509
Mailing Address - Country:US
Mailing Address - Phone:505-272-1991
Mailing Address - Fax:505-272-2016
Practice Address - Street 1:5980 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5509
Practice Address - Country:US
Practice Address - Phone:505-272-1991
Practice Address - Fax:505-272-2016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165787363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19799Medicaid
Q27186Medicare UPIN
ND19799Medicaid