Healthcare Provider Details

I. General information

NPI: 1356899405
Provider Name (Legal Business Name): KATHLEEN DAWELLA MOSLEY SPECIMEN COLLECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4479 BROADVIEW RD
CLEVELAND OH
44109-4302
US

IV. Provider business mailing address

4479 BROADVIEW RD
CLEVELAND OH
44109-4302
US

V. Phone/Fax

Practice location:
  • Phone: 216-916-9282
  • Fax: 216-823-0518
Mailing address:
  • Phone: 216-916-9282
  • Fax: 216-823-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberR7H4P2Q8
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: