Healthcare Provider Details

I. General information

NPI: 1659585750
Provider Name (Legal Business Name): MARIE A MOYER RN BSN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE A DALY STUDENT

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W IRVINGTON
TUCSON AZ
85746
US

IV. Provider business mailing address

9660 E ELM TREE CIRCLE
TUCSON AZ
85749
US

V. Phone/Fax

Practice location:
  • Phone: 520-908-4516
  • Fax: 502-908-4500
Mailing address:
  • Phone: 520-760-9221
  • Fax: 520-760-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN061956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: