Healthcare Provider Details

I. General information

NPI: 1932549961
Provider Name (Legal Business Name): MARYANN L MOYER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 E BASELINE RD
GILBERT AZ
85234-2633
US

IV. Provider business mailing address

PO BOX 7060
CHANDLER AZ
85246-7060
US

V. Phone/Fax

Practice location:
  • Phone: 480-289-3532
  • Fax:
Mailing address:
  • Phone: 480-444-2017
  • Fax: 480-545-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: