Provider Demographics
NPI:1003318585
Name:MOISII, DANNA MAVIS CONSTANCE (PA-C)
Entity type:Individual
Prefix:
First Name:DANNA
Middle Name:MAVIS CONSTANCE
Last Name:MOISII
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:MAVIS CONSTANCE
Other - Last Name:FOUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:34603 SHARKY AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8871
Mailing Address - Country:US
Mailing Address - Phone:907-921-2221
Mailing Address - Fax:907-921-2201
Practice Address - Street 1:35670 KENAI SPUR HWY STE 102
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7649
Practice Address - Country:US
Practice Address - Phone:907-921-2221
Practice Address - Fax:907-921-2201
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6949363AM0700X
TXPA11692363AM0700X
AK171496363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
168676165OtherPRACTICE NPI NUMBER