Healthcare Provider Details

I. General information

NPI: 1780981373
Provider Name (Legal Business Name): CHRISTINE L MOSEBACH APRN, ACNS-BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE L MOSEBACH APRN, ACNS-BC

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-6431
  • Fax: 573-986-5984
Mailing address:
  • Phone: 573-334-6431
  • Fax: 573-986-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2010030539
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: