Individual provider Active NPI

Joellen Moss, RN

  • Medical-Surgical Registered Nurse
  • Sycamore, IL
National Provider Identifier
1366779225
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical-Surgical Registered NurseTaxonomy code 163WM0705X
License
041192022 Issued in IL
Practice address
2111 Midlands CT
Sycamore, IL 60178-3125
Phone
(815) 758-0000
NPI assigned
Nov 12, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 041192022 IL Primary

Addresses

Primary practice location

2111 Midlands CT
Sycamore, IL 60178-3125

Mailing address

2111 Midlands CT
Sycamore, IL 60178-3125
Phone (815) 758-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
041192022ILMDMedical-Surgical Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257984000000",
    "number": "1366779225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "815-758-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "815-758-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "JOELLEN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-12",
        "last_updated": "2009-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "IL",
            "license": "041192022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.