Provider Demographics
NPI:1700028453
Name:MOSER-HARRIS, CHRISTINE JUNE (RN,ANP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JUNE
Last Name:MOSER-HARRIS
Suffix:
Gender:F
Credentials:RN,ANP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:JUNE
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,ANP
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1400 W VALENCIA RD
Practice Address - Street 2:STE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6003
Practice Address - Country:US
Practice Address - Phone:520-751-3335
Practice Address - Fax:520-751-3312
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50486363LA2200X
AZAP3879363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP13844Medicare UPIN