Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN1007537 | DC |
NPI | 1043508047 |
---|---|
Provider Name | Mrs. Jennifer Ann Moran |
First Address | Lorton, VA 22079-1356 |
Second Address | Washington, DC 20010-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 27/01/2014 |