Provider Demographics
NPI:1942817051
Name:MORENO, DEBBIE SANICO (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SANICO
Last Name:MORENO
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 PLUMERIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2685
Mailing Address - Country:US
Mailing Address - Phone:309-826-8307
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 33
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:702-880-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily