Healthcare Provider Details

I. General information

NPI: 1710492582
Provider Name (Legal Business Name): MICHELE RENEE MORITZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE RENEE REDLER

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 30TH AVE STE 12
MOLINE IL
61265-5975
US

IV. Provider business mailing address

306 46TH AVE
EAST MOLINE IL
61244-4281
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5513
  • Fax: 309-762-5513
Mailing address:
  • Phone: 309-796-2329
  • Fax: 309-796-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: