MEDICARE: MRS. AMEY LOU MOEGGENBORG PA-C

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	363A00000X	Physician Assistant	5601004378	MI

General Provider Information

NPI Number	:	1457399446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMEY LOU MOEGGENBORG PA-C

Provider Business Mailing Address
First Line	:	611 COURT ST
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9390
Country	:	US
Telephone Number	:	989-345-7000
Fax Number	:	989-345-7479

Provider Business Practice Location Address
First Line	:	611 COURT ST
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9390
Country	:	US
Telephone Number	:	989-345-7000
Fax Number	:	989-345-7479

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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