NPI 1629000682 · live from the CMS NPI Registry
Eagan Child And Family Care, P.A.
Pediatrics in Eagan, MN. National Provider Identifier 1629000682, active.
NPI record
| NPI | 1629000682 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics 208000000X |
| Practice location | 4178 Knob Dr, Suite A, Eagan, MN 55122 |
| Practice phone | 651-209-8640 |
| Enumerated | July 7, 2006 |
| Last updated | September 11, 2025 |
| Authorized official | Gretchen Moen, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | 1650 (MN) |
| Nurse Practitioner, Family | 363LF0000X | 1650 (MN) |
| Nurse Practitioner, Pediatrics | 363LP0200X | 1650 (MN) |
| Nurse Practitioner, Women's Health | 363LW0102X | 1650 (MN) |
| Pediatrics primary | 208000000X | 1650 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.