Provider Demographics
NPI:1598047706
Name:MOSS, LOIS B (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:B
Last Name:MOSS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:STE 12
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2638
Mailing Address - Country:US
Mailing Address - Phone:505-352-1708
Mailing Address - Fax:
Practice Address - Street 1:717 ENCINO PL NE STE 12
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2638
Practice Address - Country:US
Practice Address - Phone:505-242-5373
Practice Address - Fax:505-242-1221
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-01837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily