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General NPI Number Information
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NPI Number | 1730106360
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Entity Type | Individual
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Provider Name | MARTHA MOON RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 443 HOUSTON ST
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City | PORTLAND
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State | TX
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Zip | 78374-1643
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Country | US
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Telephone | 361-977-2059
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 849881
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City | DALLAS
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State | TX
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Zip | 75284-0001
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 581447
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License Number State | TX
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