Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 202120260 | NY |
NPI | 1013675495 |
---|---|
Provider Name | Rachel Anne Moody |
First Address | Wallkill, NY 12589-3259 |
Second Address | Yonkers, NY 10710-4612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |