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General NPI Number Information
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NPI Number | 1215581970
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Entity Type | Individual
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Provider Name | MICHELLE LYNN MOORE NP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 17731 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48224-1329
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Country | US
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Telephone | 734-489-9863
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Fax |
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Provider Business Mailing Address
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Address Line | 17731 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48224-1329
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP500019019
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG0012287
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R251830
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN03417
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License Number State | RI
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024183753
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704196541
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP027347
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11025305
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License Number State | FL
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