Provider Demographics
NPI:1306827183
Name:MOZURAS, JOANNE (RN, CNM, MS)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:MOZURAS
Suffix:
Gender:F
Credentials:RN, CNM, MS
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:GOBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM, MS
Mailing Address - Street 1:16151 19 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1159
Mailing Address - Country:US
Mailing Address - Phone:586-228-1760
Mailing Address - Fax:586-228-2672
Practice Address - Street 1:16151 19 MILE RD STE 300
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1159
Practice Address - Country:US
Practice Address - Phone:586-228-1760
Practice Address - Fax:586-228-2672
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704130050367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI438742Medicaid