Individual
BRANDI LEE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
220 BANNOCK ST, MALAD CITY, ID 83252-5068
(208) 766-2600
Mailing address
975 S 2100 W, MALAD CITY, ID 83252-4925
(801) 358-9683
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5061676
ID
Other
Enumeration date
10/24/2022
Last updated
08/07/2024
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