Healthcare Provider Details

I. General information

NPI: 1962873547
Provider Name (Legal Business Name): DENISE LYNN MOYER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE MOYER CNM

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 LAINHART RD
OWEGO NY
13827-4751
US

IV. Provider business mailing address

304 LAINHART RD
OWEGO NY
13827-4751
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-0463
  • Fax:
Mailing address:
  • Phone: 607-687-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: