Provider Demographics
NPI:1275557217
Name:MORIARTY LOEVEN, JENNIFER SUSAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:MORIARTY LOEVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PENNACOOK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3554
Mailing Address - Country:US
Mailing Address - Phone:603-669-7321
Mailing Address - Fax:
Practice Address - Street 1:24 PENNACOOK ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3554
Practice Address - Country:US
Practice Address - Phone:603-669-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0584363AM0700X
CAPA 19727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical