Provider Demographics
NPI:1629050786
Name:MOREAU, MARIE C (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:MOREAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0904
Mailing Address - Country:US
Mailing Address - Phone:724-996-0531
Mailing Address - Fax:724-481-1067
Practice Address - Street 1:4447 GIBSONIA RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-7998
Practice Address - Country:US
Practice Address - Phone:724-443-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104012XRNMedicare UPIN
PA104012XRUMedicare UPIN
PAQ72282Medicare UPIN