Provider Demographics
NPI:1962844738
Name:MOSER, JENNIFER M (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MOSER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-5912
Mailing Address - Fax:916-734-4098
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-4539
Practice Address - Fax:916-734-4098
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN374657163WG0100X, 163WP0200X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care