Provider Demographics
NPI:1548072721
Name:MOYER, JOHN (REGISTED NURSE)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:REGISTED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON AVE S STE 900
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2455
Mailing Address - Country:US
Mailing Address - Phone:917-939-5034
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON AVE S STE 900
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2455
Practice Address - Country:US
Practice Address - Phone:917-939-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR24761000163W00000X
NY845333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse