MEDICARE: NICOLE MOEMAI

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
1	207VX0000X	Obstetrics Physician	14197524-3400	UT

General Provider Information

NPI Number	:	1831809623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MOEMAI

Provider Business Mailing Address
First Line	:	3462 S HAWK DR
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-6016
Country	:	US
Telephone Number	:	951-396-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3462 S HAWK DR
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-6016
Country	:	US
Telephone Number	:	951-396-5540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/11/2025

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Directions to “ NICOLE MOEMAI ” Practice Location

Language	Start Address	Practice Location

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