Provider Demographics
NPI:1295246908
Name:MORENO, EVELYN MARITZA (RNFA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARITZA
Last Name:MORENO
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 STONEBRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5871
Mailing Address - Country:US
Mailing Address - Phone:626-999-7696
Mailing Address - Fax:
Practice Address - Street 1:4313 STONEBRIAR TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5871
Practice Address - Country:US
Practice Address - Phone:626-999-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10300778163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant