Healthcare Provider Details

I. General information

NPI: 1356944573
Provider Name (Legal Business Name): TONI MOOSMANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 N 460 W
PLEASANT GROVE UT
84062-3860
US

IV. Provider business mailing address

1060 12TH ST APT 402
OGDEN UT
84404-5375
US

V. Phone/Fax

Practice location:
  • Phone: 385-269-1728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4939385-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: