Provider Demographics
NPI:1942540836
Name:MOSES, JOHANNA NIROSHINI (PA-C, MPH)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:NIROSHINI
Last Name:MOSES
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:MS
Other - First Name:JOHANNA
Other - Middle Name:NIROSHINI
Other - Last Name:EPHRAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:901 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6404
Mailing Address - Country:US
Mailing Address - Phone:405-307-1000
Mailing Address - Fax:
Practice Address - Street 1:901 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6404
Practice Address - Country:US
Practice Address - Phone:405-307-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004725363A00000X
OK2213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant