Provider Demographics
NPI:1902899362
Name:MAHONEY, MORIAH B (CFNP)
Entity type:Individual
Prefix:MS
First Name:MORIAH
Middle Name:B
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 MOUNTAIN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1920
Mailing Address - Country:US
Mailing Address - Phone:505-426-7686
Mailing Address - Fax:505-471-6084
Practice Address - Street 1:2504 CAMINO ENTRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4851
Practice Address - Country:US
Practice Address - Phone:505-471-4985
Practice Address - Fax:505-471-6084
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01287363LF0000X, 208100000X
NMR53421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83871241Medicaid
NMQ47757Medicare UPIN
NM343521102Medicare ID - Type UnspecifiedMEDICARE