Provider Demographics
NPI:1326224932
Name:MOSES, JAN MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:MOSES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 SPYGLASS WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5481
Mailing Address - Country:US
Mailing Address - Phone:919-350-7844
Mailing Address - Fax:919-350-8310
Practice Address - Street 1:3024 NEW BERN AVENUE
Practice Address - Street 2:WAKEMED FACULTY PHYSICIANS- OB/GYN
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-350-7945
Practice Address - Fax:919-359-8310
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC167367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife