Provider Demographics
NPI:1124796792
Name:MOSER, MADELYN BROOKE (PA)
Entity type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:BROOKE
Last Name:MOSER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
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Practice Address - Street 1:11141 PARKVIEW PLAZA DR STE 320
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1714
Practice Address - Country:US
Practice Address - Phone:260-425-5400
Practice Address - Fax:260-425-5417
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-02-02
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Provider Licenses
StateLicense IDTaxonomies
IN10003440A363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant