Provider Demographics
NPI:1811319601
Name:MOXHAM, MYRNA F I (MSN, RN)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:F
Last Name:MOXHAM
Suffix:I
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 READS WAY
Mailing Address - Street 2:SUITE 135-136
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1649
Mailing Address - Country:US
Mailing Address - Phone:302-324-5255
Mailing Address - Fax:
Practice Address - Street 1:42 READS WAY
Practice Address - Street 2:SUITE 135-136
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1649
Practice Address - Country:US
Practice Address - Phone:302-324-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0011857163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice