Individual
MRS. DONNA JEAN MORIARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC, WHNP
Contact information
Practice address
120 HOSPITAL DR, STE 225, LEBANON, MO 65536-9238
(417) 533-6710
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
094608
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639157076
—
MO
01
—
431560263
TRICARE
MO
Enumeration date
01/05/2006
Last updated
03/25/2014
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