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NPI Code Detail

MEDICARE: MRS. ERIN L MOEN CRNP

MEDICARE: MRS. ERIN L MOEN CRNP
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
1363LA2200XAdult Health Nurse PractitionerSP009619PA
2163W00000XRegistered Nurse560570PA
3363LG0600XGerontology Nurse PractitionerSP009622PA

General Provider Information

NPI Number : 1285824987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ERIN L MOEN CRNP
Provider Business Mailing Address
First Line : PO BOX 746722
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6722
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3621 ARAMINGO AVE STE 5C
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-4607
Country : US
Telephone Number : 215-444-7472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2007
Last Update Date : 09/15/2025

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