Provider Demographics
NPI:1942567896
Name:MOYNIHAN, DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2799
Mailing Address - Country:US
Mailing Address - Phone:718-313-1474
Mailing Address - Fax:718-987-6541
Practice Address - Street 1:3155 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2799
Practice Address - Country:US
Practice Address - Phone:718-313-1474
Practice Address - Fax:718-987-6541
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse