Provider Demographics
NPI:1346743879
Name:MOUA, KABLIA TAO (RN)
Entity Type:Individual
Prefix:
First Name:KABLIA
Middle Name:TAO
Last Name:MOUA
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 1:635 IVY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3422
Mailing Address - Country:US
Mailing Address - Phone:651-771-2420
Mailing Address - Fax:651-771-2421
Practice Address - Street 1:635 IVY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3422
Practice Address - Country:US
Practice Address - Phone:651-771-2420
Practice Address - Fax:651-771-2421
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23774163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health