MEDICARE: LATOYIA SHANAE MOSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	M24053783911	IL

General Provider Information

NPI Number	:	1316775620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYIA SHANAE MOSLEY

Provider Business Mailing Address
First Line	:	5343 BELLEVILLE CROSSING ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-3108
Country	:	US
Telephone Number	:	618-977-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	5343 BELLEVILLE CROSSING ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-3108
Country	:	US
Telephone Number	:	618-977-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “ LATOYIA SHANAE MOSLEY ” Practice Location

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