Provider Demographics
NPI:1396960928
Name:MOSELEY, HARRIET JOSEPHINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:JOSEPHINE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:345 STEKOA FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-5642
Mailing Address - Country:US
Mailing Address - Phone:706-782-4078
Mailing Address - Fax:706-212-0296
Practice Address - Street 1:19 JO DOTSON CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5007
Practice Address - Country:US
Practice Address - Phone:706-212-0289
Practice Address - Fax:706-212-0296
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN045641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse