Individual
MORIAH MACKENZIE SCHALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3920 N UNION BLVD, COLORADO SPRINGS, CO 80907-4900
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0006443
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000191209
—
CO
Enumeration date
08/11/2020
Last updated
09/03/2024
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