Healthcare Provider Details

I. General information

NPI: 1740658194
Provider Name (Legal Business Name): CARRIE ELIZABETH MOYER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BEEBE AVE
NORWICH NY
13815-1701
US

IV. Provider business mailing address

31 BEEBE AVE
NORWICH NY
13815-1701
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-1600
  • Fax:
Mailing address:
  • Phone: 607-334-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number632264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: