Provider Demographics
NPI:1497369581
Name:MARSHALL MOYER, DONNA (PHD, RN, PCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:MARSHALL MOYER
Suffix:
Gender:F
Credentials:PHD, RN, PCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 OLD FIELD TRL
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3374
Mailing Address - Country:US
Mailing Address - Phone:269-760-7189
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST # 53
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196957364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics