Provider Demographics
NPI:1710767694
Name:MOREN, ALICIA JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:MOREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1044
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:
Practice Address - Street 1:421 11TH ST NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1044
Practice Address - Country:US
Practice Address - Phone:218-631-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily