Provider Demographics
NPI:1265664213
Name:MOORE, MAHRIE AMELIA (CNM, FNP-C)
Entity Type:Individual
Prefix:
First Name:MAHRIE
Middle Name:AMELIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNM, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1857
Mailing Address - Country:US
Mailing Address - Phone:607-266-7800
Mailing Address - Fax:607-216-0093
Practice Address - Street 1:20 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1857
Practice Address - Country:US
Practice Address - Phone:607-266-7800
Practice Address - Fax:607-216-0093
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001350176B00000X
NY346551363LF0000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily