Provider Demographics
NPI:1013902212
Name:MOOY, NANCIE J (CNM)
Entity Type:Individual
Prefix:MRS
First Name:NANCIE
Middle Name:J
Last Name:MOOY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-1440
Mailing Address - Fax:801-408-1441
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:STE 184
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-1440
Practice Address - Fax:801-408-1441
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT206394-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00139383Medicare PIN
UT000064902Medicare PIN
UT005754202Medicare ID - Type Unspecified
UTR82563Medicare UPIN