Provider Demographics
NPI:1851123574
Name:MOSLEY, MARTHA MICHELLE
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MICHELLE
Last Name:MOSLEY
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 1:391 JOHNS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NELLIS
Mailing Address - State:WV
Mailing Address - Zip Code:25142-9721
Mailing Address - Country:US
Mailing Address - Phone:951-290-1420
Mailing Address - Fax:
Practice Address - Street 1:4510 PENNSYLVANIA AVE STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4835
Practice Address - Country:US
Practice Address - Phone:304-965-9081
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker