Provider Demographics
NPI:1912862392
Name:MORENO, IRELAND BELOVED MAGDALEANE
Entity type:Individual
Prefix:
First Name:IRELAND
Middle Name:BELOVED MAGDALEANE
Last Name:MORENO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:NE
Mailing Address - Zip Code:69154-6114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:NE
Practice Address - Zip Code:69154-5111
Practice Address - Country:US
Practice Address - Phone:308-772-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-18
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant