MEDICARE: MS. REBECCA ELIZABETH MOON NP

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	363LW0102X	Women's Health Nurse Practitioner	0024084313	VA

General Provider Information

NPI Number	:	1578536835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA ELIZABETH MOON NP

Provider Business Mailing Address
First Line	:	118 N BOULEVARD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4304
Country	:	US
Telephone Number	:	804-359-5066
Fax Number	:	804-353-2718

Provider Business Practice Location Address
First Line	:	118 N BOULEVARD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4304
Country	:	US
Telephone Number	:	804-359-5066
Fax Number	:	804-353-2718

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/22/2012

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