Provider Demographics
NPI:1265894273
Name:WEITZ, MOIRA (CPM, CNM, ARNP)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:WEITZ
Suffix:
Gender:F
Credentials:CPM, CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9438
Mailing Address - Country:US
Mailing Address - Phone:319-521-4910
Mailing Address - Fax:
Practice Address - Street 1:4900 INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-9438
Practice Address - Country:US
Practice Address - Phone:319-521-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X, 367A00000X
IAB175232367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAB175232OtherIOWA BOARD OF NURSING