Provider Demographics
NPI:1659585750
Name:MOYER, MARIE A (RN BSN MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:MOYER
Suffix:
Gender:F
Credentials:RN BSN MA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT
Mailing Address - Street 1:9660 E ELM TREE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-760-9221
Mailing Address - Fax:520-760-9221
Practice Address - Street 1:4400 W IRVINGTON
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746
Practice Address - Country:US
Practice Address - Phone:520-908-4516
Practice Address - Fax:502-908-4500
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN061956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ594988Medicaid