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NPI Code Detail

MEDICARE: BRIANA MOON

MEDICARE: BRIANA MOON
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1770940686
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANA MOON
Provider Business Mailing Address
First Line : 4401 CONNER ST
Second Line :
City : DETROIT
State : MI
Zip : 48215-2201
Country : US
Telephone Number : 313-924-7860
Fax Number : 313-821-5759
Provider Business Practice Location Address
First Line : 4401 CONNER ST
Second Line :
City : DETROIT
State : MI
Zip : 48215-2201
Country : US
Telephone Number : 313-924-7860
Fax Number : 313-821-5759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2016
Last Update Date : 01/22/2016

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Directions to “ BRIANA MOON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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