Individual
CRESFIELD WINSLOW MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
463 S. LAKE POWELL BLVD, PAGE, AZ 86040-0790
(928) 645-0945
(925) 645-3254
Mailing address
PO BOX 790, 463 S. LAKE POWELL BLVD, PAGE, AZ 86040-0790
(928) 645-0945
(928) 645-3254
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2197
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
957152
—
AZ
01
—
AZ07272
ELECTRONIC TRADING NUMBER
AZ
01
—
AZ158651
BCBS PROVIDER NUMBER
AZ
Enumeration date
04/21/2006
Last updated
08/27/2013
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