Provider Demographics
NPI:1255533949
Name:WELLER MOORE, RHONDA J (ANP-BC, PHD)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:J
Last Name:WELLER MOORE
Suffix:
Gender:F
Credentials:ANP-BC, PHD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:J
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 S CEDAR CREST BLVD
Practice Address - Street 2:STE 310
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-6890
Practice Address - Fax:610-402-6892
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010532363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN193506LOtherLICENSE