Provider Demographics
NPI:1154563401
Name:MOEN, AMANDA M (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:MOEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-720-2803
Mailing Address - Fax:651-229-1718
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:612-365-8021
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2019-04-04
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Provider Licenses
StateLicense IDTaxonomies
MN1076342084N0402X
MN584142084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology