Healthcare Provider Details

I. General information

NPI: 1629050786
Provider Name (Legal Business Name): MARIE C MOREAU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/01/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 GIBSONIA RD
GIBSONIA PA
15044-7998
US

IV. Provider business mailing address

218 GABRIEL DR
MARS PA
16046-0904
US

V. Phone/Fax

Practice location:
  • Phone: 724-443-3220
  • Fax:
Mailing address:
  • Phone: 724-996-0531
  • Fax: 724-481-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007878
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: