Provider Demographics
NPI:1629317060
Name:MOSTON, ANNE M (LPN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MOSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CLANCY RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3210
Mailing Address - Country:US
Mailing Address - Phone:631-576-9212
Mailing Address - Fax:
Practice Address - Street 1:92 CLANCY RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3210
Practice Address - Country:US
Practice Address - Phone:631-576-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307881-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse