Provider Demographics
NPI:1659607380
Name:GOLDEN, ROBERTA M MOORE (NP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M MOORE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-2118
Mailing Address - Country:US
Mailing Address - Phone:508-674-6476
Mailing Address - Fax:508-673-0179
Practice Address - Street 1:309 FRENCH ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5441
Practice Address - Country:US
Practice Address - Phone:508-674-6476
Practice Address - Fax:508-673-0179
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN147542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily