Healthcare Provider Details

I. General information

NPI: 1528313848
Provider Name (Legal Business Name): SUSAN ANN ST. MOSLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN ANN ST.MOSLEY CRNA

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

1301 ADDINGTON CT
LAKE ORION MI
48360-2529
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-4837
  • Fax:
Mailing address:
  • Phone: 248-760-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA243035
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: