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NPI Code Detail

MEDICARE: CINDY RAE MOE LP

MEDICARE: CINDY RAE MOE LP
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
1103T00000XPsychologistLPOO94MN
2103T00000XPsychologistLP0094MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538754569
Entity Type Code : Individual
Provider Name (Legal Business Name) : CINDY RAE MOE LP
Provider Business Mailing Address
First Line : 1214 LOWRY AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-1370
Country : US
Telephone Number : 612-910-1035
Fax Number :
Provider Business Practice Location Address
First Line : 8590 EDINBURGH CENTER DR
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-3723
Country : US
Telephone Number : 763-425-5959
Fax Number : 763-425-5929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2021
Last Update Date : 03/02/2021

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