Healthcare Provider Details

I. General information

NPI: 1851916613
Provider Name (Legal Business Name): MAKINNA CAITLIN MOEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAKINNA CAITLIN OESTREICH MD

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 E MARSHALL ST # 980677
RICHMOND VA
23298-5003
US

IV. Provider business mailing address

1223 E MARSHALL ST # 980677
RICHMOND VA
23298-5003
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4230
  • Fax:
Mailing address:
  • Phone: 804-828-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number0116034518
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: