Provider Demographics
NPI:1912227505
Name:MOORE, MARCIA DIGE (RN , NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:DIGE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN , NP-C
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 676
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0676
Mailing Address - Country:US
Mailing Address - Phone:303-717-5113
Mailing Address - Fax:
Practice Address - Street 1:1351 COLLYER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3310
Practice Address - Country:US
Practice Address - Phone:303-776-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161866163W00000X
COAPN.0995935-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse