Active NPI
Pahder Moua
- Pediatric Nurse Practitioner
- Verona, WI
National Provider Identifier
1225901945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 108716630
- Practice address
- 509 W Verona Ave Apt 102
Verona, WI 53593-1567 - Phone
- (715) 432-6068
- NPI assigned
- Sep 29, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 108716630 | WI | Primary |
Addresses
Primary practice location
509 W Verona Ave Apt 102
Verona, WI 53593-1567
Mailing address
509 W Verona Ave Apt 102
Verona, WI 53593-1567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108716630 | WI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759104000000",
"number": "1225901945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 W VERONA AVE APT 102",
"city": "VERONA",
"state": "WI",
"postal_code": "535931567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 W VERONA AVE APT 102",
"city": "VERONA",
"state": "WI",
"postal_code": "535931567",
"telephone_number": "715-432-6068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUA",
"first_name": "PAHDER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-29",
"last_updated": "2025-09-29",
"certification_date": "2025-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WI",
"license": "108716630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.