1013902212 NPI number — MRS. NANCIE J MOOY CNM

Table of content: MRS. NANCIE J MOOY CNM (NPI 1013902212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013902212 NPI number — MRS. NANCIE J MOOY CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOOY
Provider First Name:
NANCIE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013902212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-408-1440
Provider Business Mailing Address Fax Number:
801-408-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 10TH AVE
Provider Second Line Business Practice Location Address:
STE 184
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84103-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-408-1440
Provider Business Practice Location Address Fax Number:
801-408-1441
Provider Enumeration Date:
09/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  206394-4402 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)