Healthcare Provider Details

I. General information

NPI: 1447753439
Provider Name (Legal Business Name): MRS. EILEEN GRACE MOYTON-LEWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 MANGO BLVD
WEST PALM BEACH FL
33411-9176
US

IV. Provider business mailing address

4281 MANGO BLVD
WEST PALM BEACH FL
33411-9176
US

V. Phone/Fax

Practice location:
  • Phone: 561-255-9873
  • Fax: 561-328-3330
Mailing address:
  • Phone: 561-255-9873
  • Fax: 561-328-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5149416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: