Provider Demographics
NPI:1023548914
Name:MOFFETT, MAUREEN ANN (CNS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 ARDLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1522
Mailing Address - Country:US
Mailing Address - Phone:215-982-0435
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:NEONATAL INTENSIVE CARE UNIT
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718
Practice Address - Country:US
Practice Address - Phone:302-733-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL4-0000001364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEL1-0045988OtherSTATE OF DELAWARE BOARD OF NURSING
DEL4-0000001OtherSTATE OF DELAWARE BOARD OF NURSING