Healthcare Provider Details

I. General information

NPI: 1639223811
Provider Name (Legal Business Name): MOUNIR MOUSSA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 HARBOUR POINTE UNIT 202
COLUMBUS OH
43231-7708
US

IV. Provider business mailing address

6150 HARBOUR POINTE UNIT 202
COLUMBUS OH
43231-7708
US

V. Phone/Fax

Practice location:
  • Phone: 614-592-0240
  • Fax: 614-523-0240
Mailing address:
  • Phone: 614-523-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number290596
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number102341
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: