Provider Demographics
NPI:1326245598
Name:DAVIS-MOON, LINDA (CRNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DAVIS-MOON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SANSOM ST.
Mailing Address - Street 2:239 THOMPSON BLDG.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-6844
Mailing Address - Fax:215-923-6225
Practice Address - Street 1:1020 SANSOM ST.
Practice Address - Street 2:239 THOMPSON BLDG.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6844
Practice Address - Fax:215-923-6225
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004940B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP004940BOtherCRNP LICENSE
PAMD0934681OtherDEA LICENSE
PAS99834Medicare UPIN