Healthcare Provider Details

I. General information

NPI: 1477357002
Provider Name (Legal Business Name): JOAN K MOKAYA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11149 IDAHO CT N
CHAMPLIN MN
55316-3324
US

IV. Provider business mailing address

11149 IDAHO CT N
CHAMPLIN MN
55316-3324
US

V. Phone/Fax

Practice location:
  • Phone: 215-578-0853
  • Fax:
Mailing address:
  • Phone: 215-578-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2476627
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: