MEDICARE: MICHAELA DEE MOREAU RN

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	163W00000X	Registered Nurse	881700	TX

General Provider Information

NPI Number	:	1841776788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA DEE MOREAU RN

Provider Business Mailing Address
First Line	:	10977 ALDER
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77328-4937
Country	:	US
Telephone Number	:	832-401-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	10977 ALDER
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77328-4937
Country	:	US
Telephone Number	:	832-401-4547
Fax Number	:

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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