MEDICARE: JANE MARIE MOODY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	RN5311	ME

General Provider Information

NPI Number	:	1841790144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE MARIE MOODY RN

Provider Business Mailing Address
First Line	:	KATAHDIN VALLEY HEALTH CENTER
Second Line	:	30 HOULTON ROAD
City	:	PATTEN
State	:	ME
Zip	:	04765-6221
Country	:	US
Telephone Number	:	207-528-2285
Fax Number	:

Provider Business Practice Location Address
First Line	:	KATAHDIN VALLEY HEALTH CENTER
Second Line	:	30 HOULTON ROAD
City	:	PATTEN
State	:	ME
Zip	:	04765-6221
Country	:	US
Telephone Number	:	207-528-2285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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