Provider Demographics
NPI:1750641882
Name:MOSER, ANGELA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:MOSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:SCHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 N COTNER BLVD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-5969
Mailing Address - Fax:402-464-3657
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE #208
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant