Provider Demographics
NPI:1063873172
Name:MOSELEY, AFRODEASIA (RN)
Entity type:Individual
Prefix:
First Name:AFRODEASIA
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-8537
Mailing Address - Country:US
Mailing Address - Phone:757-581-0157
Mailing Address - Fax:
Practice Address - Street 1:3400 PASTURE LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-8537
Practice Address - Country:US
Practice Address - Phone:757-581-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001232046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse