Healthcare Provider Details

I. General information

NPI: 1386363471
Provider Name (Legal Business Name): ELIZABETH MOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

7701 E OSBORN RD APT 309W
SCOTTSDALE AZ
85251-7452
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-1000
  • Fax:
Mailing address:
  • Phone: 253-820-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN193686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: