Individual
STEPHAN MICHAEL MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 W HOSPITAL RD, BRIGHAM CITY, UT 84302-3006
(435) 734-2041
Mailing address
600 W HOSPITAL RD, BRIGHAM CITY, UT 84302-3006
(435) 734-2041
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
10566698-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
10566698-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10566698-4405
LICENSE
UT
Enumeration date
06/15/2018
Last updated
11/21/2018
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