Provider Demographics
NPI:1588417786
Name:MOSLEY, RANDI LYNE (CNA)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LYNE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4029
Mailing Address - Country:US
Mailing Address - Phone:826-202-1317
Mailing Address - Fax:
Practice Address - Street 1:2300 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3340
Practice Address - Country:US
Practice Address - Phone:540-479-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401104332374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician