Provider Demographics
NPI:1619781127
Name:MORENO, CASANDRA LOUISE
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:LOUISE
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DOMAR DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5562
Mailing Address - Country:US
Mailing Address - Phone:734-474-2626
Mailing Address - Fax:
Practice Address - Street 1:1204 W NORFOLK AVE APT 411
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4950
Practice Address - Country:US
Practice Address - Phone:734-474-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No372500000XNursing Service Related ProvidersChore Provider