1700028453 NPI number — MRS. CHRISTINE JUNE MOSER-HARRIS RN,ANP

Table of content: MRS. CHRISTINE JUNE MOSER-HARRIS RN,ANP (NPI 1700028453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700028453 NPI number — MRS. CHRISTINE JUNE MOSER-HARRIS RN,ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSER-HARRIS
Provider First Name:
CHRISTINE
Provider Middle Name:
JUNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN,ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSER
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN,ANP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700028453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
SUITE A-100
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-327-0460
Provider Business Mailing Address Fax Number:
520-795-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 W VALENCIA RD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85746-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-751-3335
Provider Business Practice Location Address Fax Number:
520-751-3312
Provider Enumeration Date:
03/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  50486 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: AP3879 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)