Provider Demographics
NPI:1922177831
Name:MOYA, NANCY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LOUISE
Last Name:MOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAMKIN ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3476
Mailing Address - Country:US
Mailing Address - Phone:719-543-6633
Mailing Address - Fax:719-543-6655
Practice Address - Street 1:201 LAMKIN ST APT 101
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3558
Practice Address - Country:US
Practice Address - Phone:719-543-6633
Practice Address - Fax:719-543-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000144198Medicaid
CO82634343Medicaid
COH09007Medicare UPIN