Provider Demographics
NPI:1194566539
Name:MOSS, SAMANTHA JO (CNC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:MOSS
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5946
Mailing Address - Country:US
Mailing Address - Phone:623-258-2407
Mailing Address - Fax:
Practice Address - Street 1:8520 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5946
Practice Address - Country:US
Practice Address - Phone:623-258-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach