Individual
JORIE J. MOBERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, CPNP
Contact information
Practice address
9470 BROADWAY, CROWN POINT, IN 46307-5722
(219) 661-3260
(219) 661-3770
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
28142503A
IN
363L00000X
Nurse Practitioner
71002006A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71002006A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721668
ANTHEM TRADITIONAL
IN
05
—
200206460
—
IN
Enumeration date
08/12/2005
Last updated
07/31/2023
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