Provider Demographics
NPI:1679368062
Name:MOYNIHAN, JEANNETTE (RN, IBCLC, DOULA)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:RN, IBCLC, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S ELM DR APT 6
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4619
Mailing Address - Country:US
Mailing Address - Phone:310-497-6071
Mailing Address - Fax:
Practice Address - Street 1:320 S ELM DR APT 6
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4619
Practice Address - Country:US
Practice Address - Phone:310-497-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
CAL-316656163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula