Healthcare Provider Details

I. General information

NPI: 1679241236
Provider Name (Legal Business Name): DANIELLE MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 117
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

525 ROUTE 73 N STE 117
MARLTON NJ
08053-3422
US

V. Phone/Fax

Practice location:
  • Phone: 609-474-0106
  • Fax:
Mailing address:
  • Phone: 609-474-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01146900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: