Provider Demographics
NPI:1609598275
Name:MOSLEY, CHANEEN RONEE
Entity Type:Individual
Prefix:
First Name:CHANEEN
Middle Name:RONEE
Last Name:MOSLEY
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 1:9445 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2648
Mailing Address - Country:US
Mailing Address - Phone:219-285-1522
Mailing Address - Fax:219-244-4342
Practice Address - Street 1:225 W 53RD LN
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1469
Practice Address - Country:US
Practice Address - Phone:219-285-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy