Provider Demographics
NPI:1689838468
Name:MOSS, IVYE L (MLPN)
Entity Type:Individual
Prefix:MISS
First Name:IVYE
Middle Name:L
Last Name:MOSS
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Gender:F
Credentials:MLPN
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Mailing Address - Street 1:NORTHEAST HEALTH CENTER 5400 EAST 7 MILE
Mailing Address - Street 2:ROOM 25
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234
Mailing Address - Country:US
Mailing Address - Phone:313-852-4291
Mailing Address - Fax:313-368-4694
Practice Address - Street 1:CITY OF DETROIT HEALTH DEPARTMENT 1151 TAYLOR
Practice Address - Street 2:ROOM 332
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-852-4291
Practice Address - Fax:313-368-4694
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
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Provider Licenses
StateLicense IDTaxonomies
MI4703063073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse