Individual
AMANDA SUE MOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 105TH ST NW, RICE, MN 56367-8656
(320) 980-2630
Mailing address
700 105TH ST NW, RICE, MN 56367-8656
(320) 980-2630
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
1100892
MN
Other
Enumeration date
09/21/2019
Last updated
09/21/2019
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