Provider Demographics
NPI:1366563264
Name:MOFFITT, EILEEN (CPNP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3601
Mailing Address - Country:US
Mailing Address - Phone:707-447-2103
Mailing Address - Fax:
Practice Address - Street 1:401 3RD ST
Practice Address - Street 2:VAMC SF DOWNTOWN CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1214
Practice Address - Country:US
Practice Address - Phone:415-551-7309
Practice Address - Fax:415-861-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000031173N2PNP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics