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General NPI Number Information
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NPI Number | 1629000682
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Entity Type | Organization
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Legal Business Name | EAGAN CHILD AND FAMILY CARE, P.A.
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4178 KNOB DR SUITE A
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City | EAGAN
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State | MN
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Zip | 55122-2888
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Country | US
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Telephone | 651-209-8640
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Fax | 651-209-8690
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Provider Business Mailing Address
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Address Line | 4178 KNOB DR SUITE A
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City | EAGAN
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State | MN
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Zip | 55122-2888
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Country | US
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Telephone | 651-209-8640
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Fax | 651-209-8690
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRETCHEN A MOEN
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Credential | CPNP
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Telephone | 651-209-8640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1650
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1650
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1650
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1650
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1650
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License Number State | MN
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