Provider Demographics
NPI:1720737877
Name:MOSLEY-LANE, ALICIA R
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:MOSLEY-LANE
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 1:4686 RAPID RUN RD
Mailing Address - Street 2:1B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238
Mailing Address - Country:US
Mailing Address - Phone:513-815-9107
Mailing Address - Fax:
Practice Address - Street 1:4686 RAPID RUN RD
Practice Address - Street 2:1B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238
Practice Address - Country:US
Practice Address - Phone:513-815-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver