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General NPI Number Information
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NPI Number | 1073947008
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Entity Type | Individual
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Provider Name | EMILY LAUREN MOSES P.A.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 115 E 7TH ST
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City | MANTON
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State | MI
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Zip | 49663-9429
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Country | US
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Telephone | 231-824-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 6227 FRANKFORT HWY
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City | BENZONIA
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State | MI
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Zip | 49616-8632
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Country | US
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Telephone | 231-882-9661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601006735
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License Number State | MI
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