Basic Information
| Provider Information | |||||||||
| NPI: | 1457887150 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOATS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17854 VIRGINIA AVE | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217407255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404522850 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16110 EVERLY ROAD | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017140837 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LP50803 | MD | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.