Healthcare Provider Details

I. General information

NPI: 1083952683
Provider Name (Legal Business Name): MRS. SHEILA D MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA JOHNSON

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CENTRAL SCHOOL RD
REMBERT SC
29128-9589
US

IV. Provider business mailing address

55 CENTRAL SCHOOL RD
REMBERT SC
29128-9589
US

V. Phone/Fax

Practice location:
  • Phone: 803-428-3147
  • Fax: 803-428-3184
Mailing address:
  • Phone: 803-428-3147
  • Fax: 803-428-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77870
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: