Healthcare Provider Details

I. General information

NPI: 1235062803
Provider Name (Legal Business Name): CAROLYN ANN MOSCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 CORPORATE DR STE DR
TROY MI
48098-2646
US

IV. Provider business mailing address

25386 WITHERSPOON ST
FARMINGTON HILLS MI
48335-1370
US

V. Phone/Fax

Practice location:
  • Phone: 866-902-4000
  • Fax:
Mailing address:
  • Phone: 248-308-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704418159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: