Provider Demographics
NPI:1376553289
Name:MOES, DENA (RN, CNM)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MOES
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:KAZMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:712 POPPY LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3837
Mailing Address - Country:US
Mailing Address - Phone:530-828-9435
Mailing Address - Fax:
Practice Address - Street 1:574 MANZANITA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1369
Practice Address - Country:US
Practice Address - Phone:530-828-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1312OtherRN, CNM