Basic Information
| Provider Information | |||||||||
| NPI: | 1730439431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMORENO | ||||||||
| FirstName: | RAYNA | ||||||||
| MiddleName: | MARIE MOORE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPNP-PC, MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1146 | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254021146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042634999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 99 TAVERN RD | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042634999 | ||||||||
| FaxNumber: | 3042676418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | APRN89856-CPNP-PC | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | AC001066 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3334066 00 | 05 | MD | MEDICAID |