Provider Demographics
NPI:1619798550
Name:MOEN, KATHLEEN T
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:MOEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3820
Mailing Address - Country:US
Mailing Address - Phone:603-491-7468
Mailing Address - Fax:
Practice Address - Street 1:86 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-3820
Practice Address - Country:US
Practice Address - Phone:603-491-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075986-21163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics