Provider Demographics
NPI:1285416958
Name:MOSERAY, MILLICENT F (APN)
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:F
Last Name:MOSERAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 GOSSAMER CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6561
Mailing Address - Country:US
Mailing Address - Phone:570-926-2617
Mailing Address - Fax:
Practice Address - Street 1:238 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3528
Practice Address - Country:US
Practice Address - Phone:973-622-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1052203363LW0102X
NJ26NJ14904400363LW0102X
MDAC005445363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health