MEDICARE: CAROLYN ANN MORA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255699021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN ANN MORA

Provider Business Mailing Address
First Line	:	17940 LINCOLN RD
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17940 LINCOLN RD
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9641
Country	:	US
Telephone Number	:	989-845-7336
Fax Number	:

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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Directions to “ CAROLYN ANN MORA ” Practice Location

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