Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 5151014907 | MI |
NPI | 1003494105 |
---|---|
Provider Name | Dr. Elena Rae Moses |
First Address | Wyandotte, MI 48192-4668 |
Second Address | Wyandotte, MI 48192-4668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2021 |
Last Update Date | 29/09/2021 |