MEDICARE: MERCEDES MELODY MOSER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		AK

General Provider Information

NPI Number	:	1023687852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES MELODY MOSER LMT

Provider Business Mailing Address
First Line	:	8634 BLACKBERRY ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-5333
Country	:	US
Telephone Number	:	503-410-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	503-320-7680
Fax Number	:	907-269-3623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/29/2026

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