Individual
MARY KAY MOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3000
Mailing address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AA083129
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430036793
RAILROAD MEDICARE
ME
01
—
AA110623
HARVARD
ME
Enumeration date
06/14/2006
Last updated
09/30/2008
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