Provider Demographics
NPI:1265705750
Name:MOON, JULIA DIANE (WHNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:DIANE
Last Name:MOON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 US HIGHWAY 70 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-6616
Mailing Address - Country:US
Mailing Address - Phone:252-514-6594
Mailing Address - Fax:252-639-2005
Practice Address - Street 1:1230 US HIGHWAY 70 E
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6616
Practice Address - Country:US
Practice Address - Phone:252-514-6594
Practice Address - Fax:252-639-2005
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5005491363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265705750OtherNPI
NC7006103Medicaid