Healthcare Provider Details

I. General information

NPI: 1326207572
Provider Name (Legal Business Name): NINA N MOREIRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA NUANGCHAMNONG MD

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 LOUISIANA AVE S
ST LOUIS PARK MN
55426-5000
US

IV. Provider business mailing address

3931 LOUISIANA AVE S
ST LOUIS PARK MN
55426-5000
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3260
  • Fax: 952-993-1748
Mailing address:
  • Phone: 952-993-3260
  • Fax: 952-993-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number68246
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD-40186
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number68246
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number40186
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: