Provider Demographics
NPI:1407415730
Name:MOORE, MONESHA MARIA
Entity Type:Individual
Prefix:
First Name:MONESHA
Middle Name:MARIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 GILCHRIST ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1575
Mailing Address - Country:US
Mailing Address - Phone:313-422-5369
Mailing Address - Fax:
Practice Address - Street 1:29555 LAUREL WOODS DR APT 205
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4664
Practice Address - Country:US
Practice Address - Phone:313-422-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty