Provider Demographics
NPI:1285953521
Name:MOON, FELECIA LYNN (RN)
Entity type:Individual
Prefix:
First Name:FELECIA
Middle Name:LYNN
Last Name:MOON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6989
Mailing Address - Country:US
Mailing Address - Phone:845-775-3563
Mailing Address - Fax:
Practice Address - Street 1:3418 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6989
Practice Address - Country:US
Practice Address - Phone:845-343-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02200524900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse