Provider Demographics
NPI:1962628271
Name:NEW MOON, ELAINE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:NEW MOON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N CENTRAL #130
Mailing Address - Street 2:WILCOX SUMMER HAWK RANCH
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-424-1600
Mailing Address - Fax:602-532-7202
Practice Address - Street 1:4520 N CENTRAL AVE STE 130
Practice Address - Street 2:WILCOX SUMMER HAWK RANCH
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1804
Practice Address - Country:US
Practice Address - Phone:602-424-1600
Practice Address - Fax:602-532-7202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN064934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily