Provider Demographics
NPI:1598178584
Name:MORITZ, NANCY MARIE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:MORITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42145 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EMILY
Mailing Address - State:MN
Mailing Address - Zip Code:56447-4025
Mailing Address - Country:US
Mailing Address - Phone:218-763-3097
Mailing Address - Fax:218-763-7001
Practice Address - Street 1:42145 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:EMILY
Practice Address - State:MN
Practice Address - Zip Code:56447-4025
Practice Address - Country:US
Practice Address - Phone:218-763-3097
Practice Address - Fax:218-763-7001
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 80267-7163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR80267-7OtherMINNESOTA BOARD OF NURSING