MEDICARE: SUZANNE MORAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703084195	MI

General Provider Information

NPI Number	:	1003316613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MORAN

Provider Business Mailing Address
First Line	:	8196 LOON LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8196 LOON LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7255
Country	:	US
Telephone Number	:	810-516-5996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “ SUZANNE MORAN ” Practice Location

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