Healthcare Provider Details

I. General information

NPI: 1295197812
Provider Name (Legal Business Name): CODY MOYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DARROW RD #106
HUDSON OH
44236-5026
US

IV. Provider business mailing address

5700 DARROW RD #106
HUDSON OH
44236-5026
US

V. Phone/Fax

Practice location:
  • Phone: 330-656-5911
  • Fax: 330-656-5901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.369884
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: