Provider Demographics
NPI:1720556780
Name:MOSES, MONIQUE CHERIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:CHERIE
Last Name:MOSES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5730
Mailing Address - Country:US
Mailing Address - Phone:917-261-4414
Mailing Address - Fax:833-371-2040
Practice Address - Street 1:1501 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5730
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:833-371-2040
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR265297363L00000X
ID75279363L00000X
UT13199295-8900363L00000X
NV814746363LF0000X
CA95023706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily