MEDICARE: MRS. DAPHNE I MOORE

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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1164617353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAPHNE I MOORE

Provider Business Mailing Address
First Line	:	7548 ROLLING HILL RD
Second Line	:
City	:	NORTH PRINCE GEORGE
State	:	VA
Zip	:	23860-8000
Country	:	US
Telephone Number	:	804-519-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	7548 ROLLING HILL RD
Second Line	:
City	:	NORTH PRINCE GEORGE
State	:	VA
Zip	:	23860-8000
Country	:	US
Telephone Number	:	804-519-6109
Fax Number	:	804-326-2934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	02/03/2020

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