Healthcare Provider Details

I. General information

NPI: 1285210146
Provider Name (Legal Business Name): ASHLEY LYNAE MOYER DNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 FITZWATERTOWN RD STE 1
WILLOW GROVE PA
19090-1338
US

IV. Provider business mailing address

42 ROSY RIDGE CT
TELFORD PA
18969-1367
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-2012
  • Fax:
Mailing address:
  • Phone: 267-382-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP023436
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: