Provider Demographics
NPI:1740894070
Name:MOSS, RACQUEL LAJUANE
Entity type:Individual
Prefix:MS
First Name:RACQUEL
Middle Name:LAJUANE
Last Name:MOSS
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 1:4301 RUSSELL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1443
Mailing Address - Country:US
Mailing Address - Phone:202-655-8885
Mailing Address - Fax:
Practice Address - Street 1:4001 9TH ST NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3702
Practice Address - Country:US
Practice Address - Phone:202-544-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant