| Doctor Name: | LONNIE POLKOW MOCH |
| NPI Number: | 1760815013 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | 215497-0 |
| Business Practice Address: | 203 4th St Nw Bagley, MN - 566218305 |
| Business Phone Number: | 2186946501 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2168, FARGO |
| State: | ND |
| Postal Code: | 581072168 |
| Phone Number: | 7012342119 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2013 |
| NPI Last Update Date: | 12/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 215497-0 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |