Provider Demographics
NPI:1902072010
Name:RIZZO MOORE, MARYBETH (CRNP)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:RIZZO MOORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2405
Mailing Address - Country:US
Mailing Address - Phone:610-765-4200
Mailing Address - Fax:
Practice Address - Street 1:721 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2405
Practice Address - Country:US
Practice Address - Phone:610-765-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN332698L163W00000X
DELG-0001408363LF0000X
PASP012712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse