Provider Demographics
NPI:1225393523
Name:MOXIE, AUDREY MEREDITH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:MEREDITH
Last Name:MOXIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:MEREDITH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37605 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-591-7931
Mailing Address - Fax:734-464-0335
Practice Address - Street 1:37605 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-591-7931
Practice Address - Fax:734-464-0335
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant