Provider Demographics
NPI:1053583054
Name:MOYER, JENNIFER A (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MOYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2266
Mailing Address - Country:US
Mailing Address - Phone:410-869-0908
Mailing Address - Fax:800-858-8130
Practice Address - Street 1:566 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2266
Practice Address - Country:US
Practice Address - Phone:410-869-0908
Practice Address - Fax:800-858-8130
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 547692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist