Healthcare Provider Details

I. General information

NPI: 1679013171
Provider Name (Legal Business Name): JESSICA FRANCES MOSES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 DEWEY ST
BENNINGTON VT
05201-2225
US

IV. Provider business mailing address

76 GRANDMA MOSES RD
EAGLE BRIDGE NY
12057-2401
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-6314
  • Fax:
Mailing address:
  • Phone: 518-915-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0128475
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: