Provider Demographics
NPI:1912738394
Name:MOSER, CASSIE LYNN (CNP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:MOSER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:LESTER
Mailing Address - State:IA
Mailing Address - Zip Code:51242-0083
Mailing Address - Country:US
Mailing Address - Phone:605-838-5577
Mailing Address - Fax:
Practice Address - Street 1:6100 S LOUISE AVE STE 3100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6032
Practice Address - Country:US
Practice Address - Phone:605-322-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003321207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology