Provider Demographics
NPI:1851916613
Name:MOEN, MAKINNA CAITLIN (MD)
Entity type:Individual
Prefix:
First Name:MAKINNA
Middle Name:CAITLIN
Last Name:MOEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAKINNA
Other - Middle Name:CAITLIN
Other - Last Name:OESTREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:VCUHS GMEA
Mailing Address - Street 2:BOX 980257
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0257
Mailing Address - Country:US
Mailing Address - Phone:804-828-9783
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-4097
Practice Address - Fax:804-807-7943
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01160345182081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine