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General NPI Number Information
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NPI Number | 1578636924
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Entity Type | Individual
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Provider Name | ANNIE LEE MOODY NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 HADDON AVE
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City | CAMDEN
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State | NJ
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Zip | 08103-3101
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Country | US
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Telephone | 586-757-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 21 HAMPTON LN
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City | WILLINGBORO
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State | NJ
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Zip | 08046-1821
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Country | US
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Telephone | 609-835-0337
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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 | 26NJ00059200
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License Number State | NJ
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