Provider Demographics
NPI:1588660450
Name:MOSER, GAIL ANN (PAC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:MOSER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 DIAMOND STREET PL
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1554
Mailing Address - Country:US
Mailing Address - Phone:712-423-1525
Mailing Address - Fax:712-423-2528
Practice Address - Street 1:1614 DIAMOND STREET PL
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1554
Practice Address - Country:US
Practice Address - Phone:712-423-1525
Practice Address - Fax:712-423-2528
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS49091Medicare UPIN
IAI0974Medicare PIN