Provider Demographics
NPI:1487077061
Name:MOREY, TINA (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MOREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1032
Mailing Address - Country:US
Mailing Address - Phone:920-216-4879
Mailing Address - Fax:
Practice Address - Street 1:430 N WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1032
Practice Address - Country:US
Practice Address - Phone:920-216-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164196-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse