Provider Demographics
NPI:1134681380
Name:MOSLEY, MARIAH ELLEN (NMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:ELLEN
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 W MAGEE RD # 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4329
Mailing Address - Country:US
Mailing Address - Phone:520-261-5790
Mailing Address - Fax:
Practice Address - Street 1:2262 W MAGEE RD
Practice Address - Street 2:ST 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742
Practice Address - Country:US
Practice Address - Phone:520-261-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1791175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath