Healthcare Provider Details

I. General information

NPI: 1508824889
Provider Name (Legal Business Name): NANCY LYNNE MOYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 MAYFAIR AVE
HIBBING MN
55746-2923
US

IV. Provider business mailing address

516 S POKEGAMA AVE
GRAND RAPIDS MN
55744-3800
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-3441
  • Fax: 218-362-6989
Mailing address:
  • Phone: 218-293-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35768
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: