Healthcare Provider Details

I. General information

NPI: 1114306321
Provider Name (Legal Business Name): LISA MOYER MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 SENTRY PKWY W BLDG 16 SUITE 405
BLUE BELL PA
19422-2239
US

IV. Provider business mailing address

255 E 5TH ST STE 1050
CINCINNATI OH
45202-4121
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-4827
  • Fax: 877-283-0663
Mailing address:
  • Phone: 513-618-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP014529
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP014529
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: