Provider Demographics
NPI:1124392295
Name:MOE, BRIDGET HELEN (FNP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:HELEN
Last Name:MOE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 LYNDALE AVE S
Mailing Address - Street 2:STE 220
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2493
Mailing Address - Country:US
Mailing Address - Phone:612-823-8001
Mailing Address - Fax:
Practice Address - Street 1:1040 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3001
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF0711440363LF0000X
MNR161373-9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily