Provider Demographics
NPI:1699740217
Name:MOSSER, ANGELA LORINE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LORINE
Last Name:MOSSER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SIEDHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:45 MUD CREEK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-9529
Practice Address - Country:US
Practice Address - Phone:570-297-3746
Practice Address - Fax:570-297-5127
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003230B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S44054Medicare UPIN
PA500013369OtherRR MEDICARE PIN
NY01787879Medicaid
PA621427N9XMedicare PIN
S44054Medicare UPIN
PA621427N9XMedicare PIN