Healthcare Provider Details

I. General information

NPI: 1023548914
Provider Name (Legal Business Name): MAUREEN ANN MOFFETT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD NEONATAL INTENSIVE CARE UNIT
NEWARK DE
19718
US

IV. Provider business mailing address

6235 ARDLEIGH ST
PHILADELPHIA PA
19138-1522
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-2400
  • Fax:
Mailing address:
  • Phone: 215-982-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License NumberL4-0000001
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: