Healthcare Provider Details

I. General information

NPI: 1386214237
Provider Name (Legal Business Name): SIERRA DARLENE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA DARLENE FANNING

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N DIXIE HWY
HOOPESTON IL
60942-1021
US

IV. Provider business mailing address

432 S 6TH ST
WATSEKA IL
60970-1707
US

V. Phone/Fax

Practice location:
  • Phone: 217-283-8247
  • Fax:
Mailing address:
  • Phone: 815-471-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160009414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: