Provider Demographics
NPI:1013140482
Name:MOSS, JANET (APN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:PAIN MANAGEMENT CENTER
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-3333
Mailing Address - Fax:708-684-4876
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:PAIN MANAGEMENT CENTER
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-3333
Practice Address - Fax:708-684-4876
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-238387163WP0000X
IL209-001550163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management