1205371267 NPI number — MONICA L MOSEY CRNP

Table of content: MONICA L MOSEY CRNP (NPI 1205371267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205371267 NPI number — MONICA L MOSEY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSEY
Provider First Name:
MONICA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLODYNSKE
Provider Other First Name:
MONICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205371267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 S 2ND ST
Provider Second Line Business Mailing Address:
SUITE 2F
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17104-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-791-2520
Provider Business Mailing Address Fax Number:
717-703-0061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 TECHNOLOGY PKWY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-9413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-791-2520
Provider Business Practice Location Address Fax Number:
717-703-0061
Provider Enumeration Date:
12/30/2016

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: 363LF0000X , with the licence number:  SP017039 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103294372 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".