Healthcare Provider Details

I. General information

NPI: 1134381817
Provider Name (Legal Business Name): MICHELE LYNN MORAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 MARTINSBURG RD
NEWARK OH
43055-9643
US

IV. Provider business mailing address

4904 MARTINSBURG RD
NEWARK OH
43055-9643
US

V. Phone/Fax

Practice location:
  • Phone: 740-745-3378
  • Fax:
Mailing address:
  • Phone: 740-745-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN307985
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN307985
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: