MEDICARE: SUSAN MOSLEY ARNP

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	363L00000X	Nurse Practitioner	ARNP1292632	FL
2	363LF0000X	Family Nurse Practitioner	71002534A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000680063	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1659494128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MOSLEY ARNP

Provider Business Mailing Address
First Line	:	8910 PURDUE RD
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E 10TH ST STE 24
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2754
Country	:	US
Telephone Number	:	317-358-8060
Fax Number	:	317-358-8058

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/13/2011

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Directions to “ SUSAN MOSLEY ARNP” Practice Location

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