Provider Demographics
NPI:1023221520
Name:MOQUIN, TERESA A (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:A
Last Name:MOQUIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3523
Mailing Address - Country:US
Mailing Address - Phone:978-660-6071
Mailing Address - Fax:
Practice Address - Street 1:37 CLARK RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3523
Practice Address - Country:US
Practice Address - Phone:978-660-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165236163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0321559OtherPROVIDER NUMBER