Healthcare Provider Details

I. General information

NPI: 1255594123
Provider Name (Legal Business Name): MICHELLE M MORAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HUBBELL AVE
BUFFALO NY
14220-1631
US

IV. Provider business mailing address

117 HUBBELL AVE
BUFFALO NY
14220-1631
US

V. Phone/Fax

Practice location:
  • Phone: 716-713-8250
  • Fax:
Mailing address:
  • Phone: 716-713-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number531593-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: