Provider Demographics
NPI:1558678052
Name:MORA BECERRA, NANCY LISETTE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LISETTE
Last Name:MORA BECERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-566-4880
Mailing Address - Fax:740-566-4881
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-566-4880
Practice Address - Fax:740-566-4881
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125057327207R00000X
OH35121708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine