Provider Demographics
NPI:1225310873
Name:MOSER, PATRICK JOHN (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:MOSER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 BALD EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6381
Mailing Address - Country:US
Mailing Address - Phone:228-369-3334
Mailing Address - Fax:
Practice Address - Street 1:1725 PINE CONE RD S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-0030
Practice Address - Country:US
Practice Address - Phone:320-200-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4554-33363LF0000X
MN6345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100063209Medicaid