MEDICARE: LIBBY MICAELA MOSER MS, RDN, LDN

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	133V00000X	Registered Dietitian	86088997	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133V00000X	OTHER		DIETITIAN, REGISTERED

General Provider Information

NPI Number	:	1760049415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBBY MICAELA MOSER MS, RDN, LDN

Provider Business Mailing Address
First Line	:	1 N STATE ST FL 15
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3206
Country	:	US
Telephone Number	:	312-566-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 N STATE ST FL 15
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3206
Country	:	US
Telephone Number	:	312-566-7079
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	09/29/2022

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