Provider Demographics
NPI:1902287063
Name:MOISE, PATRICE MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:MARIE
Last Name:MOISE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36547 CALEANDRA ST
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-5853
Mailing Address - Country:US
Mailing Address - Phone:661-916-8990
Mailing Address - Fax:
Practice Address - Street 1:36547 CALEANDRA ST
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-5853
Practice Address - Country:US
Practice Address - Phone:661-916-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265509164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse