Provider Demographics
NPI:1811633761
Name:MOSER, HEIDI J (RN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:MOSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:HOUSATONIC
Mailing Address - State:MA
Mailing Address - Zip Code:01236-0863
Mailing Address - Country:US
Mailing Address - Phone:510-488-8025
Mailing Address - Fax:
Practice Address - Street 1:378 PARK STREET
Practice Address - Street 2:# 863 HOUSATONIC VILLAGE
Practice Address - City:HOUSATONIC
Practice Address - State:MA
Practice Address - Zip Code:01236
Practice Address - Country:US
Practice Address - Phone:510-488-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2349871163WH1000X
CA711283163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WH1000XNursing Service ProvidersRegistered NurseHospice