Individual
MS. STEPHANIE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
717 MISSION RD, FORT HALL, ID 83203-0717
(208) 238-2400
(208) 238-6292
Mailing address
PO BOX 306, FORT HALL, ID 83203-0306
(208) 238-2400
(208) 238-6292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
38506
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003399100
—
ID
Enumeration date
12/17/2009
Last updated
12/17/2009
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