Healthcare Provider Details

I. General information

NPI: 1689470684
Provider Name (Legal Business Name): CHRISTINE MOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CALUMET RD
CHESTERTON IN
46304-2428
US

IV. Provider business mailing address

4102 OAK GROVE DR
VALPARAISO IN
46383-2069
US

V. Phone/Fax

Practice location:
  • Phone: 219-327-3288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: