Provider Demographics
NPI:1871722215
Name:MOLLOY, MOIRA (CRNP)
Entity type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:N. GALEN HALL RD
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565
Mailing Address - Country:US
Mailing Address - Phone:610-743-6446
Mailing Address - Fax:610-678-0286
Practice Address - Street 1:N. GALEN HALL RD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565
Practice Address - Country:US
Practice Address - Phone:610-743-6446
Practice Address - Fax:610-678-0286
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002060C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner