Provider Demographics
NPI:1306065768
Name:MOE, CATHERINE ANN (ACNS- BC, CWOCN)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:MOE
Suffix:
Gender:F
Credentials:ACNS- BC, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 17TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2836
Mailing Address - Country:US
Mailing Address - Phone:320-235-9704
Mailing Address - Fax:
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-295-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR087309-1163WC2100X, 163WW0000X, 163WX1500X
MN0362703364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN256L0MOOtherBLUE CROSS BILING NO.
MN890000407OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
MN890000407OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
MNP57725Medicare UPIN