Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5014477 | NC |
N | 363LP2300X | Nurse Practitioner - Primary Care | 5014477 | NC |
NPI | 1033703517 |
---|---|
Provider Name | Judith Anne Moon |
First Address | Fayetteville, NC 28303-2612 |
Second Address | Fayetteville, NC 28303-4662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 27/07/2021 |