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General NPI Number Information
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NPI Number | 1831481761
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Entity Type | Individual
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Provider Name | MARTONA MOODY NP
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Gender | Female
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 700 MARVEL RD
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City | MILFORD
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State | DE
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Zip | 19963-1740
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Country | US
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Telephone | 302-422-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 515 FAIRMOUNT AVE FL 8
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City | TOWSON
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State | MD
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Zip | 21286-5466
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Country | US
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Telephone | 410-726-4591
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010371
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | L1-0040096
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License Number State | DE
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