Provider Demographics
NPI:1366004046
Name:MOSES, SYNTISHIYA RACHELLE
Entity Type:Individual
Prefix:
First Name:SYNTISHIYA
Middle Name:RACHELLE
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2110
Mailing Address - Country:US
Mailing Address - Phone:432-708-8439
Mailing Address - Fax:
Practice Address - Street 1:1303 82ND ST STE 150
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2766
Practice Address - Country:US
Practice Address - Phone:806-687-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342435164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse