MEDICARE: CASSIE LYNN MOSER CNP

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	207RG0100X	Gastroenterology Physician	CP003321	SD

General Provider Information

NPI Number	:	1912738394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE LYNN MOSER CNP

Provider Business Mailing Address
First Line	:	PO BOX 83
Second Line	:
City	:	LESTER
State	:	IA
Zip	:	51242-0083
Country	:	US
Telephone Number	:	605-838-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 S LOUISE AVE STE 3100
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-6032
Country	:	US
Telephone Number	:	605-322-6830
Fax Number	:

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

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	09/06/2024

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