1902138399 NPI number — MS. ALEXANDRA EMILY MOSS RN, APRN, NP, B.C.

Table of content: MS. ALEXANDRA EMILY MOSS RN, APRN, NP, B.C. (NPI 1902138399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902138399 NPI number — MS. ALEXANDRA EMILY MOSS RN, APRN, NP, B.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
ALEXANDRA
Provider Middle Name:
EMILY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APRN, NP, B.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSS
Provider Other First Name:
SACHA
Provider Other Middle Name:
EMILY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, APRN, NP, B.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902138399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2430 PAUL MINNIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-1724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 RUBBER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAUGATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06770-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-500-3208
Provider Business Practice Location Address Fax Number:
475-227-2085
Provider Enumeration Date:
02/10/2010

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: 163WP0808X , with the licence number:  071540 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 95014615 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008040753 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZIP: 01040 . This is a "2ND PRACTICE: RIVER VALLEY COUNSELING CENTER, INC., 303 BEECH ST., HOLYOKE, MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com