Provider Demographics
NPI:1326617564
Name:MOSHER, MELISSA D (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:MOSHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4982 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9504
Mailing Address - Country:US
Mailing Address - Phone:419-560-4818
Mailing Address - Fax:
Practice Address - Street 1:4982 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9504
Practice Address - Country:US
Practice Address - Phone:419-560-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-274433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty