Healthcare Provider Details

I. General information

NPI: 1710809900
Provider Name (Legal Business Name): LIVEWELL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16139 URANIMITE ST NW
RAMSEY MN
55303-4198
US

IV. Provider business mailing address

16139 URANIMITE ST NW
RAMSEY MN
55303-4198
US

V. Phone/Fax

Practice location:
  • Phone: 612-616-4382
  • Fax:
Mailing address:
  • Phone: 612-616-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA LYNNE MOSER
Title or Position: OWNER
Credential: FNP
Phone: 612-616-4382