Provider Demographics
NPI:1700373990
Name:MOSES, ERICA M (CNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:MOSES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 SHAWNEE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1665
Mailing Address - Country:US
Mailing Address - Phone:419-879-9394
Mailing Address - Fax:419-812-2608
Practice Address - Street 1:3745 SHAWNEE RD STE 108
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1665
Practice Address - Country:US
Practice Address - Phone:419-879-9394
Practice Address - Fax:419-812-2608
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty