Provider Demographics
NPI:1508117474
Name:MAOSA, GIDEON ABNER (STNA)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:ABNER
Last Name:MAOSA
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ARCHER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5109
Mailing Address - Country:US
Mailing Address - Phone:937-361-5499
Mailing Address - Fax:
Practice Address - Street 1:313 ARCHER DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5109
Practice Address - Country:US
Practice Address - Phone:937-361-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide