MEDICARE: RACHAEL MOYER FNP

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	363LF0000X	Family Nurse Practitioner	71008346A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972084317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL MOYER FNP

Provider Business Mailing Address
First Line	:	18094 COUNTY ROAD 40
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-6992
Country	:	US
Telephone Number	:	574-312-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 RIETH BLVD SUITE 100
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5869
Country	:	US
Telephone Number	:	574-875-1200
Fax Number	:

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

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	04/29/2023

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