Provider Demographics
NPI:1598439077
Name:MOON, STARRANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:STARRANN
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1983
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1983
Mailing Address - Country:US
Mailing Address - Phone:575-574-8136
Mailing Address - Fax:
Practice Address - Street 1:622 HIGHWAY 211
Practice Address - Street 2:
Practice Address - City:CLIFF
Practice Address - State:NM
Practice Address - Zip Code:88028-1215
Practice Address - Country:US
Practice Address - Phone:575-535-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-89226163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool