Provider Demographics
NPI:1457679961
Name:MOSS, LIA E (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:E
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 815
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4449
Mailing Address - Country:US
Mailing Address - Phone:312-926-8811
Mailing Address - Fax:312-587-9802
Practice Address - Street 1:680 N LAKE SHORE DR STE 815
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4449
Practice Address - Country:US
Practice Address - Phone:312-926-8811
Practice Address - Fax:312-587-9802
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-34-8021163W00000X
IL209008272367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-34-8021OtherLICENSE