Healthcare Provider Details

I. General information

NPI: 1114605789
Provider Name (Legal Business Name): VASILIKA NACHOLE MOSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 DALEWOOD AVE
MAPLE HEIGHTS OH
44137-3504
US

IV. Provider business mailing address

5506 DALEWOOD AVE
MAPLE HEIGHTS OH
44137-3504
US

V. Phone/Fax

Practice location:
  • Phone: 216-860-2098
  • Fax:
Mailing address:
  • Phone: 216-860-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: