Healthcare Provider Details

I. General information

NPI: 1922034933
Provider Name (Legal Business Name): GRETCHEN A MOEN DNP, APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 GRAND AVE FL 2
SAINT PAUL MN
55105-3002
US

IV. Provider business mailing address

4734 WESTMINSTER CIR
EAGAN MN
55122-2756
US

V. Phone/Fax

Practice location:
  • Phone: 651-384-1736
  • Fax: 651-666-1507
Mailing address:
  • Phone: 651-456-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number2574
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2574
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: