Healthcare Provider Details

I. General information

NPI: 1225317290
Provider Name (Legal Business Name): MARIANNE D. MOSES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANNE D. MOSES MAGEE APN

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 SOLANO ST
CORNING CA
96021-2713
US

IV. Provider business mailing address

2126 SOLANO ST
CORNING CA
96021-2713
US

V. Phone/Fax

Practice location:
  • Phone: 530-824-4002
  • Fax:
Mailing address:
  • Phone: 530-824-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001322
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: