Amanda Louise Moeggenberg, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704249865 Issued in MI

Practice address

1049 E Newell St
White Cloud, MI 49349-8795

Phone

(231) 689-7330

Fax

(231) 787-1304

NPI assigned

Oct 6, 2021

Last updated

Oct 6, 2021By the provider in NPPES

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

Other names 1

• Mrs. Amanda Louise Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1689336851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 E NEWELL ST",
            "city": "WHITE CLOUD",
            "state": "MI",
            "postal_code": "493498795",
            "telephone_number": "231-689-7330",
            "fax_number": "231-787-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 E NEWELL ST",
            "city": "WHITE CLOUD",
            "state": "MI",
            "postal_code": "493498795",
            "telephone_number": "231-689-7330",
            "fax_number": "231-787-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEGGENBERG",
        "first_name": "AMANDA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704249865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WILSON",
            "middle_name": "LOUISE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jo Anna Meyer, LMSW, QMHP
• Abby Rose Mikita, LLBSW, QIDP
• Kathryn Miller, MPH, CHES
• Zack Millis
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• Newaygo County Community Mental Health

• Registered Nurse in White Cloud, MI
• Providers in White Cloud, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.