Healthcare Provider Details

I. General information

NPI: 1861046195
Provider Name (Legal Business Name): MOYA ANNE MECKEL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GRANT AVE FL 6
SAN FRANCISCO CA
94108-4646
US

IV. Provider business mailing address

90 VALLE VIS
CARMEL VALLEY CA
93924-9615
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-3546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: