Provider Demographics
NPI:1417345687
Name:MOSS, RAQUEL (RN)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:MOSS
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 1:1100 WARBURTON AVE
Mailing Address - Street 2:4P
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1009
Mailing Address - Country:US
Mailing Address - Phone:914-720-3452
Mailing Address - Fax:
Practice Address - Street 1:1100 WARBURTON AVE
Practice Address - Street 2:4P
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1009
Practice Address - Country:US
Practice Address - Phone:914-720-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse