Provider Demographics
NPI:1780690511
Name:MOSCHKAU, CHARLENE MARIE (RN, CNP)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARIE
Last Name:MOSCHKAU
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
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Mailing Address - Street 1:15456 FILLMORE ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6207
Mailing Address - Country:US
Mailing Address - Phone:763-421-5429
Mailing Address - Fax:
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:763-712-4080
Practice Address - Fax:763-712-4128
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 053719-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP51885Medicare UPIN