Provider Demographics
NPI:1710133939
Name:MORAN, KATHLEEN JANE (CNS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JANE
Last Name:MORAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3013
Mailing Address - Country:US
Mailing Address - Phone:703-396-6194
Mailing Address - Fax:703-779-1372
Practice Address - Street 1:6565 ARLINGTON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3013
Practice Address - Country:US
Practice Address - Phone:703-396-6194
Practice Address - Fax:703-779-1372
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001141935OtherRN LICENSE