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NPI Code Detail

MEDICARE: JENNIFER NICOLE MORAN

MEDICARE: JENNIFER NICOLE MORAN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1295418895
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER NICOLE MORAN
Provider Business Mailing Address
First Line : 2811 MASON AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-6525
Country : US
Telephone Number : 810-334-8236
Fax Number :
Provider Business Practice Location Address
First Line : 6221 KING RD
Second Line :
City : MARINE CITY
State : MI
Zip : 48039-1428
Country : US
Telephone Number : 810-765-5010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2023
Last Update Date : 08/09/2023

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Directions to “ JENNIFER NICOLE MORAN ” Practice Location

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