Provider Demographics
NPI:1245835784
Name:MOSE, FLORIDAH KEMUMA
Entity type:Individual
Prefix:
First Name:FLORIDAH
Middle Name:KEMUMA
Last Name:MOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 SUMMERWOOD CIR APT 906
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7736
Mailing Address - Country:US
Mailing Address - Phone:214-718-0481
Mailing Address - Fax:
Practice Address - Street 1:9821 SUMMERWOOD CIR APT 906
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7736
Practice Address - Country:US
Practice Address - Phone:214-718-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345014164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse