Healthcare Provider Details

I. General information

NPI: 1972310589
Provider Name (Legal Business Name): AMBER MOSLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 AVENUE O
FORT MADISON IA
52627-9611
US

IV. Provider business mailing address

525 S HYDE ST
NAUVOO IL
62354-1204
US

V. Phone/Fax

Practice location:
  • Phone: 309-333-0994
  • Fax:
Mailing address:
  • Phone: 309-333-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number041503654
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041503654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: