MEDICARE: SUZANNE MOSER P.N.P.

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	363LF0000X	Family Nurse Practitioner	21752	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	21752	SC
3	363LP2300X	Primary Care Nurse Practitioner	15337	CA

General Provider Information

NPI Number	:	1407979172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MOSER P.N.P.

Provider Business Mailing Address
First Line	:	150 VALPREDA RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2973
Country	:	US
Telephone Number	:	760-736-6700
Fax Number	:	760-736-8643

Provider Business Practice Location Address
First Line	:	2051 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414
Country	:	US
Telephone Number	:	843-573-2535
Fax Number	:	843-573-2534

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	04/09/2026

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