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NPI Code Detail

MEDICARE: MICHELLE LYNN MOORE NP

MEDICARE: MICHELLE LYNN MOORE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNP500019019DC
2363LF0000XFamily Nurse PractitionerLG0012287DE
3363LF0000XFamily Nurse PractitionerR251830MD
4363LF0000XFamily Nurse PractitionerAPRN03417RI
5363LF0000XFamily Nurse Practitioner0024183753VA
6363LF0000XFamily Nurse Practitioner4704196541MI
7363LF0000XFamily Nurse PractitionerSP027347PA
8363LF0000XFamily Nurse Practitioner11025305FL

General Provider Information

NPI Number : 1215581970
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LYNN MOORE NP
Provider Business Mailing Address
First Line : 17731 E WARREN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48224-1329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17731 E WARREN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48224-1329
Country : US
Telephone Number : 734-489-9863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2019
Last Update Date : 03/04/2026

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