Healthcare Provider Details

I. General information

NPI: 1629381835
Provider Name (Legal Business Name): JAMIE DONNA MOERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE DONNA BENDELE

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 CLAYTON CT
WESTLAND MI
48186-5415
US

IV. Provider business mailing address

2814 CLAYTON CT
WESTLAND MI
48186-5415
US

V. Phone/Fax

Practice location:
  • Phone: 734-329-2412
  • Fax:
Mailing address:
  • Phone: 734-329-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703057593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: