MEDICARE: QUENYA MOULTRIE

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	363LA2200X	Adult Health Nurse Practitioner	4704349386	MI
2	363LA2100X	Acute Care Nurse Practitioner	4704349386	MI

General Provider Information

NPI Number	:	1891680468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENYA MOULTRIE

Provider Business Mailing Address
First Line	:	48270 APPLEGROVE LN
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48051-3310
Country	:	US
Telephone Number	:	586-876-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	48270 APPLEGROVE LN
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48051-3310
Country	:	US
Telephone Number	:	586-876-9776
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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Directions to “ QUENYA MOULTRIE ” Practice Location

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