Individual
BRIAN MOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
433 S 7TH ST APT 1923, MINNEAPOLIS, MN 55415-1642
(612) 305-0972
Mailing address
10056 OXBOROUGH RD, BLOOMINGTON, MN 55437-2351
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
75636-7
MN
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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