Provider Demographics
NPI:1225317290
Name:MOSES, MARIANNE D (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:D
Last Name:MOSES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MARIANNE
Other - Middle Name:D
Other - Last Name:MOSES MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2126 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-2713
Mailing Address - Country:US
Mailing Address - Phone:530-824-4002
Mailing Address - Fax:
Practice Address - Street 1:2126 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-2713
Practice Address - Country:US
Practice Address - Phone:530-824-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001322363LF0000X
CA95000297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
12273448OtherCAQH
NV1225317290Medicaid
NV1225317290Medicaid