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NPI Code Detail

MEDICARE: BRIDGET HELEN MOE FNP

MEDICARE: BRIDGET HELEN MOE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF0711440MN
2363LF0000XFamily Nurse PractitionerR161373-9MN

General Provider Information

NPI Number : 1124392295
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET HELEN MOE FNP
Provider Business Mailing Address
First Line : 6601 LYNDALE AVE S
Second Line : STE 220
City : RICHFIELD
State : MN
Zip : 55423-2493
Country : US
Telephone Number : 612-823-8001
Fax Number :
Provider Business Practice Location Address
First Line : 1040 GRAND AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3001
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2012
Last Update Date : 06/20/2019

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