Lisa Moon, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

558547 Issued in NY

Practice address

2584 Maple Ave
Palmyra, NY 14522-9372

Phone

(315) 573-0203

NPI assigned

May 31, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590883200000",
    "number": "1164046769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2584 MAPLE AVE",
            "city": "PALMYRA",
            "state": "NY",
            "postal_code": "145229372",
            "telephone_number": "315-573-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2584 MAPLE AVE",
            "city": "PALMYRA",
            "state": "NY",
            "postal_code": "145229372",
            "telephone_number": "315-573-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-31",
        "last_updated": "2020-05-31",
        "certification_date": "2020-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "558547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Anne Matzan
• Janet Lynn McIntyre I, LPN
• Kaitlyn Mierzwa
• Heather Lorraine Miller, PHARMD
• Crystal Lynn Millerd
• Katrina Ashley Narolis, PHARM.D.
• Newport Medical, PLLC
• Karen May Nickell, MD
• Christina Noone, RT (R) (M)
• Patrick Mitchell Odell Sr., LCSW

• All providers in Palmyra, NY
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.