Provider Demographics
NPI:1376884387
Name:MOGLIA, MICHELLE LYNN (CRNP, WHNP-BC, RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:MOGLIA
Suffix:
Gender:F
Credentials:CRNP, WHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 MAIN ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5810
Mailing Address - Country:US
Mailing Address - Phone:717-877-8371
Mailing Address - Fax:
Practice Address - Street 1:2407 BUTLER ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5302
Practice Address - Country:US
Practice Address - Phone:610-253-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631157-1163W00000X
PARN656018163W00000X
NY421147363LW0102X
PASP013694363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse