Healthcare Provider Details

I. General information

NPI: 1629583299
Provider Name (Legal Business Name): DANIEL MOSHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EATON AVE
HAMILTON OH
45013-2767
US

IV. Provider business mailing address

1440 BERNWALD LN
DAYTON OH
45432-3222
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.373245
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: