Provider Demographics
NPI:1275916611
Name:MOSERI, FIDELIS A (APRN)
Entity Type:Individual
Prefix:
First Name:FIDELIS
Middle Name:A
Last Name:MOSERI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 GNATCATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2842
Mailing Address - Country:US
Mailing Address - Phone:702-713-9257
Mailing Address - Fax:
Practice Address - Street 1:4431 S EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7850
Practice Address - Country:US
Practice Address - Phone:702-823-3003
Practice Address - Fax:702-478-8205
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health