Provider Demographics
NPI:1932955135
Name:MOSURE, BRYN
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:MOSURE
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 1:5974 BAYSIDE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9065
Mailing Address - Country:US
Mailing Address - Phone:614-715-7766
Mailing Address - Fax:
Practice Address - Street 1:5974 BAYSIDE RIDGE DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-9065
Practice Address - Country:US
Practice Address - Phone:614-715-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion