Provider Demographics
NPI:1083659395
Name:MOON, D'ANNE STOTT (CNM)
Entity Type:Individual
Prefix:
First Name:D'ANNE
Middle Name:STOTT
Last Name:MOON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1548
Mailing Address - Country:US
Mailing Address - Phone:435-557-0608
Mailing Address - Fax:801-216-8357
Practice Address - Street 1:1515 N 400 E STE 105
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7595
Practice Address - Country:US
Practice Address - Phone:435-557-0608
Practice Address - Fax:801-216-8357
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1910164402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife