Provider Demographics
NPI:1861421554
Name:MOSIER, MARY ELDONNA (ANP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELDONNA
Last Name:MOSIER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3953
Mailing Address - Country:US
Mailing Address - Phone:719-336-6767
Mailing Address - Fax:719-336-7217
Practice Address - Street 1:403 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3953
Practice Address - Country:US
Practice Address - Phone:719-336-6767
Practice Address - Fax:719-336-7217
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39130363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01185888Medicaid
CO01185888Medicaid
C512438Medicare ID - Type Unspecified