Provider Demographics
NPI:1669706255
Name:MOSER, AMY L (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:MOSER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NORTH MARKET STREET
Mailing Address - Street 2:P.O. BOX 429
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413
Mailing Address - Country:US
Mailing Address - Phone:330-426-9484
Mailing Address - Fax:330-426-2248
Practice Address - Street 1:132 N MARKET ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-2019
Practice Address - Country:US
Practice Address - Phone:330-426-9484
Practice Address - Fax:330-426-2248
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3039009Medicaid
OH3039009Medicaid
OHNP32722Medicare PIN
OHNP32723Medicare PIN