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NPI Code Detail

MEDICARE: DANIELLE MARIE MOON CRNP

MEDICARE: DANIELLE MARIE MOON 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
1363L00000XNurse Practitioner1-149919AL

General Provider Information

NPI Number : 1780200188
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE MARIE MOON CRNP
Provider Business Mailing Address
First Line : 1222 SOMERVILLE RD SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4351
Country : US
Telephone Number : 256-341-0152
Fax Number :
Provider Business Practice Location Address
First Line : 1222 SOMERVILLE RD SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4351
Country : US
Telephone Number : 256-341-0152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2020
Last Update Date : 06/22/2020

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