Provider Demographics
NPI:1366338790
Name:MOEN, PAULA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:MOEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2414 E SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1530
Mailing Address - Country:US
Mailing Address - Phone:918-577-3000
Mailing Address - Fax:
Practice Address - Street 1:2414 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1530
Practice Address - Country:US
Practice Address - Phone:918-577-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0043472164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse