Provider Demographics
NPI:1821971714
Name:MOSSMAN, CARLA J
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:J
Last Name:MOSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:OSWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFFS
Mailing Address - State:NE
Mailing Address - Zip Code:68015-0259
Mailing Address - Country:US
Mailing Address - Phone:402-620-1451
Mailing Address - Fax:
Practice Address - Street 1:13605 POLK PLZ APT 805
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-4138
Practice Address - Country:US
Practice Address - Phone:402-720-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEG06011765171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor