Individual
NATHANIEL MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1211 S PRAIRIE AVE APT 5505, CHICAGO, IL 60605-3663
(847) 212-9809
Mailing address
7445 KENNETH AVE, SKOKIE, IL 60076-3817
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209029267
IL
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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