Provider Demographics
NPI:1619788445
Name:MORENO, SARA P
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:P
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 1:130558 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:MINATARE
Mailing Address - State:NE
Mailing Address - Zip Code:69356-3708
Mailing Address - Country:US
Mailing Address - Phone:308-641-1011
Mailing Address - Fax:
Practice Address - Street 1:130558 COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:MINATARE
Practice Address - State:NE
Practice Address - Zip Code:69356-3708
Practice Address - Country:US
Practice Address - Phone:308-641-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore Provider