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NPI Code Detail

MEDICARE: MS. STEPHANIE M MOON APRN, BC

MEDICARE: MS. STEPHANIE M MOON APRN, BC
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 Practitioner26NJ00139400NJ

General Provider Information

NPI Number : 1306038955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STEPHANIE M MOON APRN, BC
Provider Business Mailing Address
First Line : 47 PARISH LN
Second Line :
City : WILLINGBORO
State : NJ
Zip : 08046-2707
Country : US
Telephone Number : 609-234-9665
Fax Number :
Provider Business Practice Location Address
First Line : 1072 JUSTISON ST
Second Line :
City : WILMINGTON
State : DE
Zip : 19801-5162
Country : US
Telephone Number : 302-660-3378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 12/21/2021

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