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General NPI Number Information
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NPI Number | 1770421091
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Entity Type | Individual
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Provider Name | HEATHER MOE CLS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 3520 TOWER AVE
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City | SUPERIOR
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State | WI
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Zip | 54880-5335
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Country | US
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Telephone | 715-398-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 1 VETERANS DR
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-2309
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Country | US
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Telephone | 612-725-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 12345
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License Number State | MN
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