Healthcare Provider Details

I. General information

NPI: 1932023645
Provider Name (Legal Business Name): COLLEEN ELIZABETH CURRAN MOYNAHAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43148 IRONSIDES CT
CANTON MI
48187-3051
US

IV. Provider business mailing address

43148 IRONSIDES CT
CANTON MI
48187-3051
US

V. Phone/Fax

Practice location:
  • Phone: 734-604-4566
  • Fax:
Mailing address:
  • Phone: 734-604-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025006441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: