Healthcare Provider Details

I. General information

NPI: 1356460851
Provider Name (Legal Business Name): JO ANNA MOYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

343 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-9717
  • Fax: 814-863-8464
Mailing address:
  • Phone: 814-863-9717
  • Fax: 814-863-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-206141-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP-001042-G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: