Provider Demographics
NPI:1346568037
Name:MOE, KELL BLUTE
Entity type:Individual
Prefix:MR
First Name:KELL BLUTE
Middle Name:
Last Name:MOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 WESTMINSTER ST APT 306
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3141
Mailing Address - Country:US
Mailing Address - Phone:651-675-7437
Mailing Address - Fax:
Practice Address - Street 1:1527 WESTMINSTER ST APT 306
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3141
Practice Address - Country:US
Practice Address - Phone:651-675-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171R00000X171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter