Provider Demographics
NPI:1487027744
Name:MOSES, WILLIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:55 E FLOWER ST
Mailing Address - Street 2:APT 267
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7611
Mailing Address - Country:US
Mailing Address - Phone:619-913-0168
Mailing Address - Fax:
Practice Address - Street 1:55 E FLOWER ST
Practice Address - Street 2:APT 267
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7611
Practice Address - Country:US
Practice Address - Phone:619-913-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517746163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult