Provider Demographics
NPI:1568994507
Name:MOSES, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4683 BENNING RD SE
Mailing Address - Street 2:APT A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5196
Mailing Address - Country:US
Mailing Address - Phone:202-517-4663
Mailing Address - Fax:
Practice Address - Street 1:4683 BENNING RD SE
Practice Address - Street 2:APT A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5196
Practice Address - Country:US
Practice Address - Phone:202-517-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC37Medicaid