Provider Demographics
NPI:1447753439
Name:MOYTON-LEWIN, EILEEN GRACE
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:GRACE
Last Name:MOYTON-LEWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 MANGO BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9176
Mailing Address - Country:US
Mailing Address - Phone:561-255-9873
Mailing Address - Fax:561-328-3330
Practice Address - Street 1:4281 MANGO BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-9176
Practice Address - Country:US
Practice Address - Phone:561-255-9873
Practice Address - Fax:561-328-3330
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5149416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse