Provider Demographics
NPI:1518065515
Name:MOSS, JULIE A (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MOSS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1 CAYLOR NICKEL SQ
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2529
Mailing Address - Country:US
Mailing Address - Phone:260-824-3500
Mailing Address - Fax:260-919-3419
Practice Address - Street 1:1 CAYLOR NICKEL SQ
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2529
Practice Address - Country:US
Practice Address - Phone:260-824-3500
Practice Address - Fax:260-919-3419
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002249A363LF0000X
SC3861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN911080H4Medicare PIN
INQ77186Medicare UPIN