Provider Demographics
NPI:1518289040
Name:MOSLEY, LORI ANN (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WASHINGTON ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1747
Mailing Address - Country:US
Mailing Address - Phone:315-729-8412
Mailing Address - Fax:315-729-8412
Practice Address - Street 1:144 WASHINGTON ST
Practice Address - Street 2:APT 1
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1747
Practice Address - Country:US
Practice Address - Phone:315-729-8412
Practice Address - Fax:315-729-8412
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204903-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse