Provider Demographics
NPI:1356899405
Name:MOSLEY, KATHLEEN DAWELLA (SPECIMEN COLLECTOR)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:DAWELLA
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:SPECIMEN COLLECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4302
Mailing Address - Country:US
Mailing Address - Phone:216-916-9282
Mailing Address - Fax:216-823-0518
Practice Address - Street 1:4479 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4302
Practice Address - Country:US
Practice Address - Phone:216-916-9282
Practice Address - Fax:216-823-0518
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR7H4P2Q8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1356899405OtherNPI