Provider Demographics
NPI:1376795849
Name:MOYER, JOSHUA AMADEUS (APN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AMADEUS
Last Name:MOYER
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:JANKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11035 LAVENDER HILL DR # 160-587
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2955
Mailing Address - Country:US
Mailing Address - Phone:702-330-3490
Mailing Address - Fax:702-800-8450
Practice Address - Street 1:8515 EDNA AVE STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4441
Practice Address - Country:US
Practice Address - Phone:702-330-3490
Practice Address - Fax:702-800-8450
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN50595163W00000X
NVAPN001074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBN724WMedicare PIN