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General NPI Number Information
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NPI Number | 1942151436
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Entity Type | Individual
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Provider Name | DEREK BRIAN MOORE RN
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Gender | Male
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 37 COLLEGE AVE S
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City | SAINT JOSEPH
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State | MN
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Zip | 56374-2001
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Country | US
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Telephone | 320-363-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 604 17TH ST N
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City | SARTELL
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State | MN
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Zip | 56377-1684
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Country | US
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Telephone | 612-414-8277
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 216202-7
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License Number State | MN
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