MEDICARE: MRS. EILEEN GRACE MOYTON-LEWIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5149416	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447753439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN GRACE MOYTON-LEWIN

Provider Business Mailing Address
First Line	:	4281 MANGO BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-9176
Country	:	US
Telephone Number	:	561-255-9873
Fax Number	:	561-328-3330

Provider Business Practice Location Address
First Line	:	4281 MANGO BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-9176
Country	:	US
Telephone Number	:	561-255-9873
Fax Number	:	561-328-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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