Stephanie Moss, RN
Individual provider Active NPI Registered Nurse · Fort Hall, ID
NPI 1700115995 · NPPES record last updated Dec 17, 2009
Key facts
- NPI
- 1700115995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 38506 (MT)
- Practice address
- 717 Mission Rd
Fort Hall, ID 83203-0717 - Phone
- (208) 238-2400
- Fax
- (208) 238-6292
- NPI assigned
- Dec 17, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38506 | MT | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 38506 | MT | Yes |
Addresses
Primary practice location
717 Mission Rd
Fort Hall, ID 83203-0717
Mailing address
PO Box 306
Fort Hall, ID 83203-0306
Phone (208) 238-2400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003399100 | Medicaid | ID |
Other providers in Fort Hall, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.