Healthcare Provider Details

I. General information

NPI: 1699602037
Provider Name (Legal Business Name): KEYIERA EILEEN MOORING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRANK LLOYD WRIGHT DR STE L-4000
ANN ARBOR MI
48105-9484
US

IV. Provider business mailing address

9839 JOAN CIR
YPSILANTI MI
48197-8295
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-6755
  • Fax: 734-557-3995
Mailing address:
  • Phone: 909-495-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451024898
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: