Provider Demographics
NPI:1780262428
Name:MOALEU, EUGENIE
Entity type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:MOALEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3254
Mailing Address - Country:US
Mailing Address - Phone:214-499-5527
Mailing Address - Fax:
Practice Address - Street 1:839 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3254
Practice Address - Country:US
Practice Address - Phone:214-499-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000812127376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide