Stacie J Moen, FNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

230520 Issued in ND

Practice address

4177 S Columbia Rd Ste 106
Grand Forks, ND 58201-7787

Phone

(701) 757-3747

Fax

(701) 757-3747

NPI assigned

Nov 19, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1083575062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 7TH ST N",
            "city": "THOMPSON",
            "state": "ND",
            "postal_code": "582784153",
            "telephone_number": "701-330-2310",
            "fax_number": "701-330-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4177 S COLUMBIA RD STE 106",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017787",
            "telephone_number": "701-757-3747",
            "fax_number": "701-757-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "STACIE",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-19",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ND",
            "license": "230520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Modeen, LCSW
• Susan Ann Moe Paulson
• Brandon James Moeller, DPT
• Heather Moen, LAC
• Shyanne Moen
• Michaela Moffett
• Lori C Mohagen, LAC
• Peggy M Mohr, PT
• Thomas Michael Mohr, P.T.
• Tiana Rose Moilanen, LCSW

• Primary Care Nurse Practitioner in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Primary Care Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.