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NPI Code Detail

MEDICARE: JORIE J. MOBERLEY PHD, CPNP

MEDICARE: JORIE J. MOBERLEY PHD, CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0200XPediatric Registered Nurse28142503AIN
2363L00000XNurse Practitioner71002006AIN
3363LP0200XPediatric Nurse Practitioner71002006AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000721668OTHERINANTHEM TRADITIONAL

General Provider Information

NPI Number : 1093717746
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORIE J. MOBERLEY PHD, CPNP
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number : 317-865-1479
Provider Business Practice Location Address
First Line : 9470 BROADWAY
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-5722
Country : US
Telephone Number : 219-661-3260
Fax Number : 219-661-3770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 07/31/2023

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