Provider Demographics
NPI:1255856522
Name:MOSELEY, LAKINA (DHED)
Entity Type:Individual
Prefix:DR
First Name:LAKINA
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:DHED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2002
Mailing Address - Country:US
Mailing Address - Phone:313-355-3873
Mailing Address - Fax:
Practice Address - Street 1:19601 CRUSADE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205
Practice Address - Country:US
Practice Address - Phone:313-355-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other