Active NPI
Amy Gomez Moreno, CNA
- Nurse's Aide
- Chehalis, WA
National Provider Identifier
1124600770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- NC60871841
- Practice address
- 500 SE Washington Ave
Chehalis, WA 98532-3058 - Phone
- (360) 748-4776
- NPI assigned
- Apr 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | NC60871841 | WA | Primary |
Addresses
Primary practice location
500 SE Washington Ave
Chehalis, WA 98532-3058
Mailing address
500 SE Washington Ave
Chehalis, WA 98532-3058
Phone (360) 748-4776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2077844 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NC60871841 | WA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1124600770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SE WASHINGTON AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985323058",
"telephone_number": "360-748-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SE WASHINGTON AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985323058",
"telephone_number": "360-748-4776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ MORENO",
"first_name": "AMY",
"credential": "CNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "WA",
"license": "NC60871841",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2077844",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.