Provider Demographics
NPI:1801334420
Name:MOSER, NERISSA
Entity type:Individual
Prefix:MS
First Name:NERISSA
Middle Name:
Last Name:MOSER
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 1:720 S DOBSON RD
Mailing Address - Street 2:UNIT 20
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2747
Mailing Address - Country:US
Mailing Address - Phone:714-474-6222
Mailing Address - Fax:
Practice Address - Street 1:1500 E THOMAS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5708
Practice Address - Country:US
Practice Address - Phone:714-474-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker