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Individual

RUSSELL MOEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7332 HIGHWAY 19, DEVILS LAKE, ND 58301-8835
(701) 393-4461
Mailing address
114 10TH ST NW, DEVILS LAKE, ND 58301-2028
(701) 331-4701

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Enumeration date
10/15/2020
Last updated
10/15/2020
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