MEDICARE: VASILIKA NACHOLE MOSBY

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1114605789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASILIKA NACHOLE MOSBY

Provider Business Mailing Address
First Line	:	5506 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3504
Country	:	US
Telephone Number	:	216-860-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	5506 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3504
Country	:	US
Telephone Number	:	216-860-2098
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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Directions to “ VASILIKA NACHOLE MOSBY ” Practice Location

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