Provider Demographics
NPI:1811392434
Name:MOOSMAN, TALEAH (RN)
Entity Type:Individual
Prefix:
First Name:TALEAH
Middle Name:
Last Name:MOOSMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:LOA
Mailing Address - State:UT
Mailing Address - Zip Code:84747-0326
Mailing Address - Country:US
Mailing Address - Phone:435-836-1316
Mailing Address - Fax:435-836-1337
Practice Address - Street 1:18 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LOA
Practice Address - State:UT
Practice Address - Zip Code:84747
Practice Address - Country:US
Practice Address - Phone:435-836-1316
Practice Address - Fax:436-836-1337
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8002271-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse