Provider Demographics
NPI:1477189520
Name:MORAN, ELIZABETH (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 E SHENNUM DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7718
Mailing Address - Country:US
Mailing Address - Phone:907-373-3420
Mailing Address - Fax:907-376-7847
Practice Address - Street 1:2650 E BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8302
Practice Address - Country:US
Practice Address - Phone:907-373-3420
Practice Address - Fax:907-376-7847
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO995312-CNM367A00000X
AK160109367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife