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General NPI Number Information
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NPI Number | 1740578749
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Entity Type | Organization
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Legal Business Name | MINNESOTA ARTHRITIS CENTER, PA
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 2785 WHITE BEAR AVE N SUITE 108B
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1307
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Country | US
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Telephone | 651-282-0948
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Fax | 651-415-0106
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Provider Business Mailing Address
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Address Line | 2785 WHITE BEAR AVE N SUITE 108 B
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1307
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Country | US
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Telephone | 651-282-0948
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Fax | 651-415-0106
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DR. NANCY L MOYER
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Credential | MD
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Telephone | 651-282-0948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35768
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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