Healthcare Provider Details

I. General information

NPI: 1306628276
Provider Name (Legal Business Name): MARY E MOYER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 POWELL ST
NORRISTOWN PA
19401-3303
US

IV. Provider business mailing address

2229 WHARTON RD
GLENSIDE PA
19038-4805
US

V. Phone/Fax

Practice location:
  • Phone: 610-279-6095
  • Fax:
Mailing address:
  • Phone: 610-762-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP028430
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: