Provider Demographics
NPI:1316546229
Name:MOLTZAN, DENISE MICHELLE (RN, CDCES)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:MOLTZAN
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 LADY AMBER LN
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-8079
Mailing Address - Country:US
Mailing Address - Phone:214-458-8050
Mailing Address - Fax:682-205-1137
Practice Address - Street 1:1304 LADY AMBER LN
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-8079
Practice Address - Country:US
Practice Address - Phone:214-458-8050
Practice Address - Fax:682-205-1137
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257390163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator