MEDICARE: MRS. SHEILA D MOSES

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	163W00000X	Registered Nurse	77870	SC

General Provider Information

NPI Number	:	1083952683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEILA D MOSES

Provider Business Mailing Address
First Line	:	55 CENTRAL SCHOOL RD
Second Line	:
City	:	REMBERT
State	:	SC
Zip	:	29128-9589
Country	:	US
Telephone Number	:	803-428-3147
Fax Number	:	803-428-3184

Provider Business Practice Location Address
First Line	:	55 CENTRAL SCHOOL RD
Second Line	:
City	:	REMBERT
State	:	SC
Zip	:	29128-9589
Country	:	US
Telephone Number	:	803-428-3147
Fax Number	:	803-428-3184

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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