Healthcare Provider Details

I. General information

NPI: 1912470014
Provider Name (Legal Business Name): DANIELLE MORIARTY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST STE 504
FOUNTAIN HILL PA
18015-1153
US

IV. Provider business mailing address

238 JEFFERSON ST
EAST GREENVILLE PA
18041-1625
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3648
  • Fax:
Mailing address:
  • Phone: 610-858-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberSP019160
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP019160
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: