Basic Information
Provider Information | |||||||||
NPI: | 1952549123 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOYER-FUCHS | ||||||||
FirstName: | TINA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HODOWANEC | ||||||||
OtherFirstName: | TINA | ||||||||
OtherMiddleName: | MOYER | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2500 BERNVILLE RD | ||||||||
Address2: |   | ||||||||
City: | READING | ||||||||
State: | PA | ||||||||
PostalCode: | 19605 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6103782000 | ||||||||
FaxNumber: | 6103782799 | ||||||||
Practice Location | |||||||||
Address1: | 2500 BERNVILLE RD | ||||||||
Address2: |   | ||||||||
City: | READING | ||||||||
State: | PA | ||||||||
PostalCode: | 19605 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6103782000 | ||||||||
FaxNumber: | 6103782799 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2009 | ||||||||
LastUpdateDate: | 08/31/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/31/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP010162 | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LN0000X | SP010162 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.