Provider Demographics
NPI:1154478832
Name:MOYNIHAN, CATHY DENISE (DNP-FNP-BC-CDE)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:DENISE
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:DNP-FNP-BC-CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:14680 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2510
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:224-225-0375
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209004308Medicaid
IL209004308Medicaid