Provider Demographics
NPI:1104716984
Name:MOSER, AMY RENEE (PMHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:MOSER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 1ST ST NW APT 10
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2755
Mailing Address - Country:US
Mailing Address - Phone:218-684-4009
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2855
Practice Address - Country:US
Practice Address - Phone:218-634-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12942363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health