Provider Demographics
NPI:1639957616
Name:MOFFOR, RELINDIS ANGIRISA
Entity type:Individual
Prefix:
First Name:RELINDIS
Middle Name:ANGIRISA
Last Name:MOFFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 HILO AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5620
Mailing Address - Country:US
Mailing Address - Phone:651-283-3546
Mailing Address - Fax:
Practice Address - Street 1:330 EXCHANGE ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2311
Practice Address - Country:US
Practice Address - Phone:651-227-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN164080-9163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator