Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | R-3540 | AR |
Y | 2080P0203X | Pediatric Critical Care Doctor | R-3540 | AR |
NPI | 1285724849 |
---|---|
Provider Name | Marie Michele Moss |
First Address | Little Rock, AR 72202-3510 |
Second Address | Little Rock, AR 72202-3510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110913001 | (05) | AR |
D79831 | (02) |