MEDICARE: BRIAN MOSELLE

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	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1952031585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MOSELLE

Provider Business Mailing Address
First Line	:	2254 5TH ST SE
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-4803
Country	:	US
Telephone Number	:	612-964-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 1ST AVE NE
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-1515
Country	:	US
Telephone Number	:	612-964-7700
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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Directions to “ BRIAN MOSELLE ” Practice Location

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