Provider Demographics
NPI:1740079029
Name:MOYA, ROSA M
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:MOYA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3515
Mailing Address - Country:US
Mailing Address - Phone:308-930-8157
Mailing Address - Fax:
Practice Address - Street 1:2309 N HUSTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2147
Practice Address - Country:US
Practice Address - Phone:308-930-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker