Provider Demographics
NPI:1396561601
Name:MOSSER, CARRIE GRACE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:GRACE
Last Name:MOSSER
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 1:304 S SALINA ST APT 2T
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1638
Mailing Address - Country:US
Mailing Address - Phone:540-487-0748
Mailing Address - Fax:
Practice Address - Street 1:304 S SALINA ST APT 2T
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1638
Practice Address - Country:US
Practice Address - Phone:540-487-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered