Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | MORO-OFTJL6 | NC |
NPI | 1023656956 |
---|---|
Provider Name | Desiree Moro |
First Address | Fort Bragg, NC 28307-2016 |
Second Address | Fayetteville, NC 28304-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2019 |
Last Update Date | 10/12/2019 |