Provider Demographics
NPI:1891807665
Name:MORENO, AURA MERCEDES (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:AURA
Middle Name:MERCEDES
Last Name:MORENO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AURA
Other - Middle Name:MERCEDES
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2 SUTPHIN PNES
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3461
Mailing Address - Country:US
Mailing Address - Phone:484-714-9866
Mailing Address - Fax:
Practice Address - Street 1:635 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6332
Practice Address - Country:US
Practice Address - Phone:610-984-1380
Practice Address - Fax:833-908-2291
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN138995163WP0808X
AZAP2419363LP0808X
PATP006641363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111775Medicare PIN
AZZ111774Medicare PIN
PAO71592Medicare UPIN
AZZ111774Medicare PIN