Healthcare Provider Details

I. General information

NPI: 1508534751
Provider Name (Legal Business Name): DANIEL MOEGI APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH ST NW STE A
FARIBAULT MN
55021-5090
US

IV. Provider business mailing address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6830
  • Fax: 651-431-7757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8351
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: