Provider Demographics
NPI:1699067744
Name:MOYER, SONYA LEMARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:LEMARIE
Last Name:MOYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SPRING GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BRUSHTON
Mailing Address - State:NY
Mailing Address - Zip Code:12916-4111
Mailing Address - Country:US
Mailing Address - Phone:518-529-4172
Mailing Address - Fax:
Practice Address - Street 1:3 SPRING GROVE RD
Practice Address - Street 2:
Practice Address - City:BRUSHTON
Practice Address - State:NY
Practice Address - Zip Code:12916-4111
Practice Address - Country:US
Practice Address - Phone:518-529-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281628164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse