Provider Demographics
NPI:1376107300
Name:MORAN, MARTHA ELAINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELAINE
Last Name:MORAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2273
Mailing Address - Country:US
Mailing Address - Phone:972-938-0100
Mailing Address - Fax:972-937-9073
Practice Address - Street 1:120 S GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2273
Practice Address - Country:US
Practice Address - Phone:972-938-0100
Practice Address - Fax:972-937-9073
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140888OtherFNP-C
TX689222OtherRN