Healthcare Provider Details

I. General information

NPI: 1649816083
Provider Name (Legal Business Name): SANDRA JUNE MOE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 10TH AVE N
BILLINGS MT
59101-0703
US

IV. Provider business mailing address

PO BOX 1191
RED LODGE MT
59068-1191
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberMED-NUTR-LIC-78826
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: