Provider Demographics
NPI:1629050786
Name:MOREAU, MARIE C (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:MOREAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:112 MARWOOD RD SUITE 5000
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023
Mailing Address - Country:US
Mailing Address - Phone:724-352-4448
Mailing Address - Fax:724-352-4412
Practice Address - Street 1:112 MARWOOD ROAD SUITE 5000
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023
Practice Address - Country:US
Practice Address - Phone:724-352-4448
Practice Address - Fax:724-352-4412
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104012XRNMedicare UPIN
PA104012XRUMedicare UPIN
PAQ72282Medicare UPIN