Doctor Name: | JENNILEE S MOE |
NPI Number: | 1477832723 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.A. |
License Number: | 1589 |
Business Practice Address: | 8100 Northland Dr Bloomington, MN - 554314800 |
Business Phone Number: | 9528318742 |
Business Fax Number: | 9528065512 |
Mailing Address: | 8100 Northland Dr, BLOOMINGTON |
State: | MN |
Postal Code: | 554314800 |
Phone Number: | 9528318742 |
Fax Number: | 9528065512 |
NPI Enumeration Date: | 08/04/2011 |
NPI Last Update Date: | 11/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 1589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |