Provider Demographics
NPI:1730266479
Name:MOORE, MARIAN FRANCES IRIS (RN CNM)
Entity type:Individual
Prefix:
First Name:MARIAN FRANCES
Middle Name:IRIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 TWIG AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5700
Mailing Address - Country:US
Mailing Address - Phone:707-829-7880
Mailing Address - Fax:415-473-5005
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-473-4117
Practice Address - Fax:415-473-5005
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377751163WW0101X
CA705367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife