Provider Demographics
NPI:1194332452
Name:MOORE, MEAGAN (ND)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E BROADWAY RD APT 1036
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1746
Mailing Address - Country:US
Mailing Address - Phone:575-538-1627
Mailing Address - Fax:
Practice Address - Street 1:3143 N 32ND ST STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6283
Practice Address - Country:US
Practice Address - Phone:602-975-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1901175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath