Healthcare Provider Details

I. General information

NPI: 1821409079
Provider Name (Legal Business Name): ELIZABETH MARIE MOYNIHAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE NEIDERER

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

12111 WAYLAND ST
OAKTON VA
22124-2235
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3783
  • Fax:
Mailing address:
  • Phone: 610-453-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1026978
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: