Provider Demographics
NPI:1801897418
Name:MORAN, ANDREA (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3421
Mailing Address - Country:US
Mailing Address - Phone:203-263-7354
Mailing Address - Fax:203-263-7354
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:CANCER CENTER
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2875
Practice Address - Country:US
Practice Address - Phone:860-679-2100
Practice Address - Fax:860-679-4815
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1801897418Medicaid
CT500002240Medicare PIN
CTQ03554Medicare UPIN