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General NPI Number Information
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NPI Number | 1962520841
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Entity Type | Individual
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Provider Name | MARY THURSTON MOYNAHAN FNP, BC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 109 EXETER STREET
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City | MANTEO
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State | NC
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Zip | 27954-1000
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Country | US
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Telephone | 252-475-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 189 HIGH DUNE LOOP
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City | KITTY HAWK
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State | NC
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Zip | 27949-3710
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Country | US
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Telephone | 252-261-1222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201043
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License Number State | NC
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