Provider Demographics
NPI:1952645301
Name:MOLDOVAN, CORNELIA (CORNELIA MOLDOVAN)
Entity Type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:CORNELIA MOLDOVAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9937 WAXHAW HWY
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9937 WAXHAW HWY
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8978
Practice Address - Country:US
Practice Address - Phone:704-201-6903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLC-090-036172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker