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General NPI Number Information
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NPI Number | 1588118111
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Entity Type | Individual
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Provider Name | NATHAN ALAN MOSS AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 1215 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3126
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Country | US
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Telephone | 928-773-2200
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Fax | 928-773-2151
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Provider Business Mailing Address
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Address Line | 2467 S CLIFFVIEW ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2989
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Country | US
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Telephone | 208-818-6181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP8631
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License Number State | AZ
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