Provider Demographics
NPI:1194470435
Name:JOHN, MORIAH (HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 1300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5230
Mailing Address - Country:US
Mailing Address - Phone:801-486-4877
Mailing Address - Fax:
Practice Address - Street 1:120 W 1300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5230
Practice Address - Country:US
Practice Address - Phone:801-486-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172V00000X
UT1689-22172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker