Provider Demographics
NPI:1598551780
Name:MOEN, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MOEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 CHANTRY PL
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9015
Mailing Address - Country:US
Mailing Address - Phone:614-432-0131
Mailing Address - Fax:614-432-0131
Practice Address - Street 1:10150 CHANTRY PL
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9015
Practice Address - Country:US
Practice Address - Phone:614-432-0131
Practice Address - Fax:614-432-0131
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion