Healthcare Provider Details

I. General information

NPI: 1851038806
Provider Name (Legal Business Name): ANATOLIY S MOROZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 ANDRIEUX ST
SONOMA CA
95476-6811
US

IV. Provider business mailing address

PO BOX 3015
NOVATO CA
94948-3015
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5000
  • Fax:
Mailing address:
  • Phone: 856-313-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: