Healthcare Provider Details

I. General information

NPI: 1922780451
Provider Name (Legal Business Name): LIA MICHELLE MOYER DNP, AGACNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIA GRIST

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOPER AVE STE 3100
SAGINAW MI
48602-5182
US

IV. Provider business mailing address

2119 CAROLINA ST
MIDLAND MI
48642-5753
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-5626
  • Fax:
Mailing address:
  • Phone: 864-238-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704319599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: