Healthcare Provider Details

I. General information

NPI: 1396534814
Provider Name (Legal Business Name): DORIANN C MOORE-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CLARENDON DR
DARBY PA
19023-1108
US

IV. Provider business mailing address

24 CLARENDON DR
DARBY PA
19023-1108
US

V. Phone/Fax

Practice location:
  • Phone: 484-981-3955
  • Fax:
Mailing address:
  • Phone: 484-981-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN731181
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: