MEDICARE: JOAN ELIZABETH MOSS RN, MSN

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	632563	TX

General Provider Information

NPI Number	:	1407634520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ELIZABETH MOSS RN, MSN

Provider Business Mailing Address
First Line	:	355 E PARKWOOD AVE
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5760
Country	:	US
Telephone Number	:	409-939-1123
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 E PARKWOOD AVE
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5760
Country	:	US
Telephone Number	:	409-939-1123
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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