Provider Demographics
NPI:1629162581
Name:MORETZ, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MORETZ
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 1:203 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50475-5008
Mailing Address - Country:US
Mailing Address - Phone:641-892-4495
Mailing Address - Fax:
Practice Address - Street 1:203 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:IA
Practice Address - Zip Code:50475-5008
Practice Address - Country:US
Practice Address - Phone:641-892-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102152363AM0700X
IA001894363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2751357AMedicare ID - Type Unspecified
NCS74407Medicare UPIN