Healthcare Provider Details

I. General information

NPI: 1710411012
Provider Name (Legal Business Name): DIANA M MOSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA M CVENGROS RN

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N MERIDIAN RD
YOUNGSTOWN OH
44509-1227
US

IV. Provider business mailing address

527 N MERIDIAN RD
YOUNGSTOWN OH
44509-1227
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-0070
  • Fax: 330-797-9146
Mailing address:
  • Phone: 330-797-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9351724
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.201738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: