Provider Demographics
NPI:1043202005
Name:MOSER, LINDA M (ANP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:MOSER
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 1:53 PUBLIC SQ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-782-4950
Mailing Address - Fax:315-782-3699
Practice Address - Street 1:53 PUBLIC SQ
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-782-4950
Practice Address - Fax:315-782-3699
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301709363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02327975Medicaid
NY02327975Medicaid
NY02327975Medicaid
NY31336FMedicare ID - Type Unspecified