Provider Demographics
NPI:1689653024
Name:WRISTEN, MOIRA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:E
Last Name:WRISTEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-795-4783
Mailing Address - Fax:520-547-5797
Practice Address - Street 1:6565 E CARONDELET DR STE 275
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3529
Practice Address - Country:US
Practice Address - Phone:520-298-0147
Practice Address - Fax:520-298-7404
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ29118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561044Medicaid
AZ561044Medicaid
AZG33511Medicare UPIN