Provider Demographics
NPI:1164015848
Name:MOY, RAYMOND (DNP, RN)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MOY
Suffix:
Gender:M
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 W MONTROSE AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1125
Mailing Address - Country:US
Mailing Address - Phone:773-931-2648
Mailing Address - Fax:
Practice Address - Street 1:3639 W MONTROSE AVE APT 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1125
Practice Address - Country:US
Practice Address - Phone:773-931-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.402567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse