Basic Information
Provider Information | |||||||||
NPI: | 1164408589 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOSHER | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | LORETTO | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ANP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 617 BIORKA ST | ||||||||
Address2: |   | ||||||||
City: | SITKA | ||||||||
State: | AK | ||||||||
PostalCode: | 998357629 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9077473182 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 209 MOLLER AVE | ||||||||
Address2: |   | ||||||||
City: | SITKA | ||||||||
State: | AK | ||||||||
PostalCode: | 998357142 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9077471723 | ||||||||
FaxNumber: | 9077470351 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/17/2005 | ||||||||
LastUpdateDate: | 06/30/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 373 | AK | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.