Healthcare Provider Details

I. General information

NPI: 1033103429
Provider Name (Legal Business Name): NATALIE JEAN MOYNIHAN MS APRN BC CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TAMARACK RD
SOMERSET NJ
08873-2923
US

IV. Provider business mailing address

4 TAMARACK RD
SOMERSET NJ
08873-2923
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-2849
  • Fax: 732-246-4264
Mailing address:
  • Phone: 732-246-2849
  • Fax: 732-246-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NC02602100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: