Individual
MRS. JUDITH ANNE MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(636) 386-7222
(636) 386-7810
Mailing address
PO BOX 22407, SAINT LOUIS, MO 63126-0407
(636) 386-7222
(636) 386-7810
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
128948
MO
367500000X
Certified Registered Nurse Anesthetist
APN0000010072
TN
367500000X
Certified Registered Nurse Anesthetist
C01016
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143653701
—
AR
05
—
3629651
—
TN
01
—
4068895
BLUE CROSS TN PROV #
TN
01
—
5T743
BLUE CROSS AR PROV #
AR
01
—
900418777
RR MEDICARE
MO
05
—
911331007
—
MO
Enumeration date
09/02/2005
Last updated
02/12/2016
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