Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | APRN92044 | WV |
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN92044 | WV |
NPI | 1053649723 |
---|---|
Provider Name | Mrs. Carissa Anne Moser |
First Address | Morgantown, WV 26507-1615 |
Second Address | Morgantown, WV 26505-3494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2009 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810029856 | (05) | WV |