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NPI Code Detail

MEDICARE: JENNA MOE AA

MEDICARE: JENNA MOE AA
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
1367H00000XAnesthesiologist Assistant511WI

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 : 1811606304
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA MOE AA
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 414-219-2000
Fax Number : 414-385-1590
Provider Business Practice Location Address
First Line : 945 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1305
Country : US
Telephone Number : 414-219-2000
Fax Number : 414-385-1590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2022
Last Update Date : 02/23/2026

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Directions to “ JENNA MOE AA” Practice Location

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