Provider Demographics
NPI:1417680661
Name:MOYLAN, MICHELE SARA (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SARA
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:SARA
Other - Last Name:GREENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-4338
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR MIDWIFERY AND WOMEN'S HEALTH
Practice Address - Street 2:789 HOWARD AVENUE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-785-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16.000520367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife