Healthcare Provider Details

I. General information

NPI: 1124965371
Provider Name (Legal Business Name): MOZIE VAN RAAIJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 N YELLOW SPRINGS ST
SPRINGFIELD OH
45504-2463
US

IV. Provider business mailing address

474 N YELLOW SPRINGS ST
SPRINGFIELD OH
45504-2463
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-9500
  • Fax:
Mailing address:
  • Phone: 937-399-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.533322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: