Healthcare Provider Details

I. General information

NPI: 1639799745
Provider Name (Legal Business Name): ELIZABETH C MOE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 09/29/2026
Certification Date: 10/10/2022
Deactivation Date: 10/10/2022
Reactivation Date: 09/29/2026

III. Provider practice location address

420 E 1ST ST
DULUTH MN
55805-1901
US

IV. Provider business mailing address

420 E 1ST ST
DULUTH MN
55805-1901
US

V. Phone/Fax

Practice location:
  • Phone: 919-561-3639
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7206
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: