Provider Demographics
NPI:1982156444
Name:MOUA, MARY JOY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOY
Last Name:MOUA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:713 MINNEHAHA AVE E
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4441
Mailing Address - Country:US
Mailing Address - Phone:651-644-5355
Mailing Address - Fax:651-644-1625
Practice Address - Street 1:713 MINNEHAHA AVE E
Practice Address - Street 2:SUITE 218
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4441
Practice Address - Country:US
Practice Address - Phone:651-644-5355
Practice Address - Fax:651-644-1625
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR160929-3163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health