Provider Demographics
NPI:1053732057
Name:MOSCA, VICTORIA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:MOSCA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 WICKER AVE.
Mailing Address - Street 2:LAKE CENTRAL SCHOOL CORPORATION
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-8507
Mailing Address - Fax:
Practice Address - Street 1:8400 WICKER AVE
Practice Address - Street 2:LAKE CENTRAL HIGH SCHOOL
Practice Address - City:ST. JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373
Practice Address - Country:US
Practice Address - Phone:219-365-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28121434A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse