Provider Demographics
NPI:1194609461
Name:MOSER, JACI MARIE (RN)
Entity type:Individual
Prefix:
First Name:JACI
Middle Name:MARIE
Last Name:MOSER
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 1:1179 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51241-7702
Mailing Address - Country:US
Mailing Address - Phone:605-359-8145
Mailing Address - Fax:
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122650163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency