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General NPI Number Information
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NPI Number | 1306038955
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Entity Type | Individual
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Provider Name | STEPHANIE M MOON APRN, BC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1072 JUSTISON ST
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City | WILMINGTON
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State | DE
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Zip | 19801-5162
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Country | US
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Telephone | 302-660-3378
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Fax |
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Provider Business Mailing Address
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Address Line | 47 PARISH LN
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City | WILLINGBORO
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State | NJ
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Zip | 08046-2707
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Country | US
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Telephone | 609-234-9665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00139400
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License Number State | NJ
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