Healthcare Provider Details

I. General information

NPI: 1487206504
Provider Name (Legal Business Name): MORIAH MACDONALD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORIAH CARVER

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

IV. Provider business mailing address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

V. Phone/Fax

Practice location:
  • Phone: 740-901-0416
  • Fax:
Mailing address:
  • Phone: 740-901-0416
  • Fax: 740-901-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.415840
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: