Provider Demographics
NPI:1649046533
Name:MOGENI, ALICE (RN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MOGENI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 530
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4521
Mailing Address - Country:US
Mailing Address - Phone:161-241-4058
Mailing Address - Fax:888-229-8312
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 530
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4521
Practice Address - Country:US
Practice Address - Phone:161-241-4058
Practice Address - Fax:888-229-8312
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2104263163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management