Provider Demographics
NPI:1194831875
Name:MOSTER, MARY D (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:D
Last Name:MOSTER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 ALBERT LONG DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-2473
Mailing Address - Country:US
Mailing Address - Phone:540-434-0898
Mailing Address - Fax:540-433-9268
Practice Address - Street 1:3302 ALBERT LONG DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2473
Practice Address - Country:US
Practice Address - Phone:540-434-0898
Practice Address - Fax:540-433-9268
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024089814363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007780427Medicaid
541258300OtherTAX ID VALLEY CHILDRENS