Provider Demographics
NPI:1891824983
Name:MOSES-NUNLEY, DIANNA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:N
Last Name:MOSES-NUNLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12142 SPANISH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3152
Mailing Address - Country:US
Mailing Address - Phone:314-438-8905
Mailing Address - Fax:
Practice Address - Street 1:58 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-916-5800
Practice Address - Fax:636-916-0146
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-29P103T00000X
MO2007028984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist