Healthcare Provider Details

I. General information

NPI: 1225738628
Provider Name (Legal Business Name): DARLA JEAN MOYER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST
ELYRIA OH
44035-6400
US

IV. Provider business mailing address

125 E BROAD ST
ELYRIA OH
44035-6400
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7397
  • Fax:
Mailing address:
  • Phone: 440-329-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0033389
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number0033389
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: