MEDICARE: RAVEN NICOLE 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	164W00000X	Licensed Practical Nurse	132544	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528566601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN NICOLE MOSLEY

Provider Business Mailing Address
First Line	:	2505 WASHINGTON CIR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5210
Country	:	US
Telephone Number	:	513-237-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 WASHINGTON CIR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5210
Country	:	US
Telephone Number	:	513-237-5096
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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Directions to “ RAVEN NICOLE MOSLEY ” Practice Location

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