Provider Demographics
NPI:1053761890
Name:MOSSMAN, ANDREW (NP-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MOSSMAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SW NAITO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3512
Mailing Address - Country:US
Mailing Address - Phone:888-288-4715
Mailing Address - Fax:833-260-2594
Practice Address - Street 1:20046 WALKER RD STE 7
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3645
Practice Address - Country:US
Practice Address - Phone:888-288-4715
Practice Address - Fax:833-260-2594
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008610363LF0000X
OR10019107363LF0000X, 363LP0808X
OHAPRN.CNP.025844363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily