MEDICARE: CHRISTINA MARIE MOYERS MS, RD, LD

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	133V00000X	Registered Dietitian	640	WV
2	133V00000X	Registered Dietitian	977331	WV

General Provider Information

NPI Number	:	1568490290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE MOYERS MS, RD, LD

Provider Business Mailing Address
First Line	:	622 HUGHES ST
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-1810
Country	:	US
Telephone Number	:	304-872-9388
Fax Number	:	304-872-6206

Provider Business Practice Location Address
First Line	:	400 FAIRVIEW HEIGHTS ROAD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-1810
Country	:	US
Telephone Number	:	304-872-8512
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/25/2011

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