Provider Demographics
NPI:1164915872
Name:MOON, JOYCE HASKINS (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:HASKINS
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 1:5524 WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4343
Mailing Address - Country:US
Mailing Address - Phone:804-627-1467
Mailing Address - Fax:804-418-3578
Practice Address - Street 1:5524 WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4343
Practice Address - Country:US
Practice Address - Phone:804-627-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001177653163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management