Individual
MICHELLE A MOYNIHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
285 OLD WESTPORT RD, DARTMOUTH, MA 02747-2356
(508) 999-8982
Mailing address
77 WARREN STREET, 3RD FL, PROVIDER ENROLLMENT DEPT, BRIGHTON, MA 02135
(617) 562-5359
(617) 562-5415
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
187390
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0321290
—
MA
Enumeration date
11/07/2005
Last updated
12/21/2012
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