Individual
BEANCA SADA MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
128 W PLEASANT ST APT O2, MANLIUS, NY 13104-1716
(315) 427-7543
Mailing address
128 W PLEASANT ST APT O2, MANLIUS, NY 13104-1716
(315) 427-7543
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
328809-1
NY
Other
Enumeration date
01/26/2019
Last updated
01/26/2019
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