Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024168097 | VA |
NPI | 1407099740 |
---|---|
Provider Name | Lisa Z Moss |
First Address | Richmond, VA 23226-1930 |
Second Address | Richmond, VA 23226-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06695 | GROUP PTAN (01) | VA |