Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | NP18939 | CA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704227573 | MI |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NP18939 | CA |
NPI | 1407042930 |
---|---|
Provider Name | Tina Marie Moran |
First Address | Madison Heights, MI 48067 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 17/03/2018 |