Provider Demographics
NPI:1306205018
Name:MOISE, ANA MARIA
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:MOISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-6082
Mailing Address - Country:US
Mailing Address - Phone:413-429-8110
Mailing Address - Fax:413-523-0261
Practice Address - Street 1:52 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3025
Practice Address - Country:US
Practice Address - Phone:413-429-8110
Practice Address - Fax:413-523-0261
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003801133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered