Individual
MAHAMAN LAOUALI MOUSSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4692 BROWNSBORO ROAD, WINSTON - SALEM, NC 27106
(336) 251-1114
(336) 251-1116
Mailing address
4692 BROWNSBORO ROAD, WINSTON - SALEM, NC 27106
(336) 251-1114
(336) 251-1116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5004034
NC
363LF0000X
Family Nurse Practitioner
200356
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2593362A
MEDICARE
NC
Enumeration date
07/29/2008
Last updated
01/29/2009
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