Provider Demographics
NPI:1861671950
Name:MOSZER, JEAN RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:RENEE
Last Name:MOSZER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:RENEE
Other - Last Name:ODLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3320 35 AVE S
Mailing Address - Street 2:#204
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5130
Mailing Address - Country:US
Mailing Address - Phone:701-729-1532
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0653130164W00000X
NDL11719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse