Provider Demographics
NPI:1174833099
Name:MOYLAN, BRIAN R (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:MOYLAN
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 217787
Mailing Address - Street 2:
Mailing Address - City:GMF BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921
Mailing Address - Country:US
Mailing Address - Phone:671-475-4005
Mailing Address - Fax:671-475-4006
Practice Address - Street 1:988 ARMY DR.
Practice Address - Street 2:STE. 4
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-475-4005
Practice Address - Fax:671-475-4006
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURX0524163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health