Provider Demographics
NPI:1417318643
Name:SUNDAY, MOSES ETIM
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:ETIM
Last Name:SUNDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOSES
Other - Middle Name:ETIM
Other - Last Name:SUNDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:119 HARVARD STREET
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-0230
Mailing Address - Country:US
Mailing Address - Phone:774-240-8742
Mailing Address - Fax:
Practice Address - Street 1:119 HARVARD ST
Practice Address - Street 2:119 HARVARD STREET
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5264
Practice Address - Country:US
Practice Address - Phone:774-240-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse