Healthcare Provider Details

I. General information

NPI: 1821592676
Provider Name (Legal Business Name): DEBRA GIULIANA MOORE-ZIEROW FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/07/2023
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MAIN ST SUITE A
MATHEWS VA
23109
US

IV. Provider business mailing address

PO BOX 327
MATHEWS VA
23109-0327
US

V. Phone/Fax

Practice location:
  • Phone: 804-725-3041
  • Fax: 804-725-3510
Mailing address:
  • Phone: 804-725-3041
  • Fax: 804-725-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001135008
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165298
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024165298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: