Provider Demographics
NPI:1245582758
Name:MOSES, VICKI BLANSETT (CPM)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:BLANSETT
Last Name:MOSES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2703
Mailing Address - Country:US
Mailing Address - Phone:612-922-4784
Mailing Address - Fax:952-564-3262
Practice Address - Street 1:6111 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2703
Practice Address - Country:US
Practice Address - Phone:612-922-4784
Practice Address - Fax:952-564-3262
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife