Provider Demographics
NPI:1962556894
Name:MOSES, GLENDA (FNP)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 EASTMORELAND AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3591
Mailing Address - Country:US
Mailing Address - Phone:901-729-3700
Mailing Address - Fax:901-729-3750
Practice Address - Street 1:1325 EASTMORELAND AVE STE 245
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3591
Practice Address - Country:US
Practice Address - Phone:901-729-3700
Practice Address - Fax:901-729-3750
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000085495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner