Individual
LISA ROSE MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102
(701) 232-3241
(701) 237-2637
Mailing address
2101 ELM ST N, FARGO, ND 58102
(701) 232-3241
(701) 237-2637
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R34505
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84203
—
ND
Enumeration date
09/27/2012
Last updated
01/02/2026
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