Provider Demographics
NPI:1629233606
Name:MOSES, ELLEN DENISE (MASTECTOMY FITTER)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:DENISE
Last Name:MOSES
Suffix:
Gender:F
Credentials:MASTECTOMY FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 SCOTT PLANTATION DR S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-9447
Mailing Address - Country:US
Mailing Address - Phone:740-727-4833
Mailing Address - Fax:
Practice Address - Street 1:2965 SCOTT PLANTATION DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-9447
Practice Address - Country:US
Practice Address - Phone:740-727-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies