Healthcare Provider Details

I. General information

NPI: 1750177481
Provider Name (Legal Business Name): MOXIE MEDISPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N72W13350 LUND LN
MENOMONEE FALLS WI
53051-4674
US

IV. Provider business mailing address

N72W13350 LUND LN
MENOMONEE FALLS WI
53051-4674
US

V. Phone/Fax

Practice location:
  • Phone: 262-350-9888
  • Fax:
Mailing address:
  • Phone: 262-350-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX AMANDA FOLEY
Title or Position: FOUNDER
Credential: APRN
Phone: 414-322-5643