Healthcare Provider Details

I. General information

NPI: 1609598275
Provider Name (Legal Business Name): CHANEEN RONEE MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W 53RD LN
MERRILLVILLE IN
46410-1469
US

IV. Provider business mailing address

9445 INDIANAPOLIS BLVD
HIGHLAND IN
46322-2648
US

V. Phone/Fax

Practice location:
  • Phone: 219-285-1522
  • Fax:
Mailing address:
  • Phone: 219-285-1522
  • Fax: 219-244-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: