Healthcare Provider Details

I. General information

NPI: 1952680944
Provider Name (Legal Business Name): MEGAN MOFFATT RN, BSN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

IV. Provider business mailing address

347 SMITH AVE N CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
SAINT PAUL MN
55102-2387
US

V. Phone/Fax

Practice location:
  • Phone: 651-726-2812
  • Fax:
Mailing address:
  • Phone: 651-220-6705
  • Fax: 651-220-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3792
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: