Healthcare Provider Details

I. General information

NPI: 1679761746
Provider Name (Legal Business Name): KIANA M GOULD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2007
Last Update Date: 10/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CONNECTICUT DR STE 5
BURLINGTON NJ
08016-4177
US

IV. Provider business mailing address

61 OXFORD ST
BRIDGETON NJ
08302-2930
US

V. Phone/Fax

Practice location:
  • Phone: 180-095-0606
  • Fax:
Mailing address:
  • Phone: 856-459-5499
  • Fax: 856-451-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05933000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: