Healthcare Provider Details

I. General information

NPI: 1578536835
Provider Name (Legal Business Name): REBECCA ELIZABETH MOON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N BOULEVARD
RICHMOND VA
23220-4304
US

IV. Provider business mailing address

118 N BOULEVARD
RICHMOND VA
23220-4304
US

V. Phone/Fax

Practice location:
  • Phone: 804-359-5066
  • Fax: 804-353-2718
Mailing address:
  • Phone: 804-359-5066
  • Fax: 804-353-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024084313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: