Provider Demographics
NPI:1629966536
Name:MOSS, MARY SUSAN (DNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:MOSS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:510 MAGNA DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6357
Mailing Address - Country:US
Mailing Address - Phone:336-314-8527
Mailing Address - Fax:336-314-8527
Practice Address - Street 1:20 DUKE MEDICINE CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2000
Practice Address - Country:US
Practice Address - Phone:919-421-8158
Practice Address - Fax:919-613-4082
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5022489363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health