Individual
STEFFANY KATE MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5997
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5997
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
01072472
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
11754
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1470166
—
ND
05
—
201171690
—
IN
Enumeration date
03/31/2010
Last updated
07/21/2022
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