Healthcare Provider Details

I. General information

NPI: 1598178584
Provider Name (Legal Business Name): NANCY MARIE MORITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42145 BIRCHWOOD DR
EMILY MN
56447-4025
US

IV. Provider business mailing address

42145 BIRCHWOOD DR
EMILY MN
56447-4025
US

V. Phone/Fax

Practice location:
  • Phone: 218-763-3097
  • Fax: 218-763-7001
Mailing address:
  • Phone: 218-763-3097
  • Fax: 218-763-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 80267-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: