Provider Demographics
NPI:1265860100
Name:MORAN, DARLA (PA-C)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10903 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3420
Mailing Address - Country:US
Mailing Address - Phone:952-933-1150
Mailing Address - Fax:952-930-3304
Practice Address - Street 1:10903 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3420
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:952-930-3304
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2014-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN11464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant