Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71006265A | IN |
NPI | 1154772465 |
---|---|
Provider Name | Debra A Moon |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-2479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 19/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201412030 | (05) | IN |