Healthcare Provider Details

I. General information

NPI: 1164015848
Provider Name (Legal Business Name): RAYMOND MOY DNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

IV. Provider business mailing address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

V. Phone/Fax

Practice location:
  • Phone: 779-252-8212
  • Fax: 312-278-4836
Mailing address:
  • Phone: 779-252-8212
  • Fax: 312-278-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209022888
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.402567
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: