Provider Demographics
NPI:1346728474
Name:MOSES, RAVEN D (LVN)
Entity Type:Individual
Prefix:MRS
First Name:RAVEN
Middle Name:D
Last Name:MOSES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1347
Mailing Address - Country:US
Mailing Address - Phone:409-293-9022
Mailing Address - Fax:
Practice Address - Street 1:111 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1347
Practice Address - Country:US
Practice Address - Phone:409-293-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317986164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse