MEDICARE: MISS DEBORAH ROSE MOSS-GAIL CRNP

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	RN574461	PA
2	363LF0000X	Family Nurse Practitioner	SP010535	PA

General Provider Information

NPI Number	:	1184947947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBORAH ROSE MOSS-GAIL CRNP

Provider Business Mailing Address
First Line	:	2300 W MASTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4996
Country	:	US
Telephone Number	:	215-707-0499
Fax Number	:	215-707-0480

Provider Business Practice Location Address
First Line	:	2300 W MASTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4996
Country	:	US
Telephone Number	:	215-707-0499
Fax Number	:	215-707-0480

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	09/27/2019

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