Provider Demographics
NPI:1851691083
Name:MORAN, ROBERT (MSN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W HILLSIDE RD # 1
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3141
Mailing Address - Country:US
Mailing Address - Phone:956-235-1056
Mailing Address - Fax:
Practice Address - Street 1:1501 E BUSTAMANTE ST STE D
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-8905
Practice Address - Country:US
Practice Address - Phone:956-235-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630856363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care