Healthcare Provider Details

I. General information

NPI: 1700373990
Provider Name (Legal Business Name): ERICA M MOSES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 SHAWNEE RD STE 108
LIMA OH
45806-1665
US

IV. Provider business mailing address

3745 SHAWNEE RD STE 108
LIMA OH
45806-1665
US

V. Phone/Fax

Practice location:
  • Phone: 419-879-9394
  • Fax: 419-812-2608
Mailing address:
  • Phone: 419-879-9394
  • Fax: 419-812-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022624
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: