MEDICARE: PAULA MOCH FNP-BC

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	363LF0000X	Family Nurse Practitioner	R31126	ND
2	363L00000X	Nurse Practitioner	R31126	ND

Other Identifiers

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

General Provider Information

NPI Number	:	1851633804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA MOCH FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	701-712-4500
Fax Number	:	701-712-4098

Provider Business Practice Location Address
First Line	:	401 N 9TH ST
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58501-4506
Country	:	US
Telephone Number	:	701-712-4500
Fax Number	:	701-712-4098

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

Provider Enumeration Date	:	03/17/2013
Last Update Date	:	11/19/2021

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