Provider Demographics
NPI:1487857553
Name:MOERMAN, MARCIA (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:MOERMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 EDGEMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2340
Mailing Address - Country:US
Mailing Address - Phone:269-342-4412
Mailing Address - Fax:
Practice Address - Street 1:7000 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-0102
Practice Address - Country:US
Practice Address - Phone:269-833-1226
Practice Address - Fax:269-833-9189
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704122019363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMM0982670OtherDEA NUMBER