Provider Demographics
NPI:1164510988
Name:MOSEMAN, CAROL J (RN, RCS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:MOSEMAN
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S AFTON RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-8749
Mailing Address - Country:US
Mailing Address - Phone:608-365-4375
Mailing Address - Fax:
Practice Address - Street 1:1305 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1495
Practice Address - Country:US
Practice Address - Phone:608-361-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38275500OtherSTATE PROVIDER NUMBER