Individual
STEPHANIE MAKUMI MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
1900 SCENIC DR STE 1114, GEORGETOWN, TX 78626-7724
(512) 248-2200
(512) 248-1950
Mailing address
8240 N MOPAC EXPY STE 100, AUSTIN, TX 78759-8869
(512) 610-5339
(512) 407-9010
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
1108827
TX
Other
Enumeration date
02/06/2023
Last updated
08/16/2023
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