Healthcare Provider Details

I. General information

NPI: 1528622255
Provider Name (Legal Business Name): JENNIFER MARIE MOYNIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S MAIN ST
ANDOVER MA
01810-4136
US

IV. Provider business mailing address

6 DANA ST
SOMERVILLE MA
02145-3001
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-4503
  • Fax:
Mailing address:
  • Phone: 781-307-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: