Provider Demographics
NPI:1366439879
Name:MOSELEY, GEORGE RALPH (CRNA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RALPH
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17486 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9019
Mailing Address - Country:US
Mailing Address - Phone:907-726-0937
Mailing Address - Fax:
Practice Address - Street 1:17486 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9019
Practice Address - Country:US
Practice Address - Phone:907-726-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-07829367500000X
AK368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered