Provider Demographics
NPI:1578899795
Name:MORIARTY, ELIZABETH A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:NP-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:ISLAND HEALTH CARE, INC.
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-9000
Mailing Address - Country:US
Mailing Address - Phone:508-939-0717
Mailing Address - Fax:508-939-8644
Practice Address - Street 1:245 VINEYARD HAVEN RD
Practice Address - Street 2:ISLAND HEALTH CARE, INC.
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-9000
Practice Address - Country:US
Practice Address - Phone:508-939-0717
Practice Address - Fax:508-939-8644
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA280805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1578899795Medicare PIN