MEDICARE: TAI MOSLEY

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205771235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAI MOSLEY

Provider Business Mailing Address
First Line	:	2302 30TH AVE S APT 524
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6522
Country	:	US
Telephone Number	:	701-317-3984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 30TH AVE S APT 524
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6522
Country	:	US
Telephone Number	:	701-317-3984
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “ TAI MOSLEY ” Practice Location

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