Provider Demographics
NPI:1467579284
Name:MOYNIHAN, CORNELIA R (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:R
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N G ST APT A2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2282
Mailing Address - Country:US
Mailing Address - Phone:253-250-2630
Mailing Address - Fax:253-759-2333
Practice Address - Street 1:2102 N ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-6637
Practice Address - Country:US
Practice Address - Phone:253-759-2300
Practice Address - Fax:253-759-2333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001473175F00000X
WAAC00002814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath