Individual provider · Type 1 NPI
Ethan Juno Moon
Student in an Organized Health Care Education/Training Program · Rockville, MD
Practice location
11140 Rockville Pike Ste 100
Rockville, MD 20852-3149
Fax (240) 877-0511
Mailing address
354 Southwood Dr
Oxford, AL 36203-5020
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
3 other providers at this address
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About NPI 1366316259
Ethan Juno Moon's National Provider Identifier is 1366316259, issued on Oct 2, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Rockville, MD. The record was last updated on Oct 2, 2025.