Provider Demographics
NPI:1174498125
Name:MOOSE, JENNIFER ANN (CNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MOOSE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-1531
Mailing Address - Country:US
Mailing Address - Phone:563-217-9439
Mailing Address - Fax:563-568-3966
Practice Address - Street 1:101 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1531
Practice Address - Country:US
Practice Address - Phone:563-217-9439
Practice Address - Fax:563-568-3966
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide