Provider Demographics
NPI:1285385179
Name:MOUSSA NOMA, SALAMATOU
Entity type:Individual
Prefix:
First Name:SALAMATOU
Middle Name:
Last Name:MOUSSA NOMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5459
Mailing Address - Country:US
Mailing Address - Phone:513-884-9128
Mailing Address - Fax:
Practice Address - Street 1:411 RADCLIFFE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5459
Practice Address - Country:US
Practice Address - Phone:513-884-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA61463601251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health