Provider Demographics
NPI:1003148867
Name:STREETER-MOYE, STACI G (ANP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:G
Last Name:STREETER-MOYE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PALADIN DRIVE
Mailing Address - Street 2:EASTERN NEPHROLOGY ASSOCIATES, PLLC
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7826
Mailing Address - Country:US
Mailing Address - Phone:252-752-8880
Mailing Address - Fax:252-752-3084
Practice Address - Street 1:511 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-752-8880
Practice Address - Fax:252-752-3084
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004620363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health