Provider Demographics
NPI:1386159440
Name:MORAN, MARIE BRIDGET (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:BRIDGET
Last Name:MORAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 MOSER AVE UNIT 207
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429-5244
Mailing Address - Country:US
Mailing Address - Phone:732-996-2641
Mailing Address - Fax:
Practice Address - Street 1:251 MOSER AVE UNIT 207
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429
Practice Address - Country:US
Practice Address - Phone:732-996-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007826363LP0808X
AZAP10575363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health