Provider Demographics
NPI:1760469274
Name:MOSHER, ROSE MARY (RNCNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE MARY
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:RNCNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-539-5060
Mailing Address - Fax:310-539-7899
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:STE 352
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-539-5060
Practice Address - Fax:310-539-7899
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANPF6035363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
W13154Medicare UPIN