Individual provider Active NPI

Relindis Angirisa Moffor

  • Administrator Registered Nurse
  • Saint Paul, MN
National Provider Identifier
1639957616
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Administrator Registered NurseTaxonomy code 163WA2000X
License
164080-9 Issued in MN
Practice address
330 Exchange St S
Saint Paul, MN 55102-2311
Phone
(651) 227-0336
NPI assigned
Sep 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Administrator Registered Nurse 163WA2000X 164080-9 MN Primary

Addresses

Primary practice location

330 Exchange St S
Saint Paul, MN 55102-2311

Mailing address

1597 Hilo Ave N
Oakdale, MN 55128-5620
Phone (651) 283-3546

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

LicenseStateTypeSpecialty
164080-9MNMDAdministrator Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1639957616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1597 HILO AVE N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285620",
            "telephone_number": "651-283-3546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 EXCHANGE ST S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022311",
            "telephone_number": "651-227-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFOR",
        "first_name": "RELINDIS",
        "middle_name": "ANGIRISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "MN",
            "license": "164080-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.