Healthcare Provider Details

I. General information

NPI: 1023687852
Provider Name (Legal Business Name): MERCEDES MELODY MOSER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 LAUREL ST
ANCHORAGE AK
99508-5334
US

IV. Provider business mailing address

8634 BLACKBERRY ST
ANCHORAGE AK
99502-5333
US

V. Phone/Fax

Practice location:
  • Phone: 503-320-7680
  • Fax: 907-269-3623
Mailing address:
  • Phone: 503-410-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: