Provider Demographics
NPI:1700189636
Name:MOSS, TONYA MARETTA
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MARETTA
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:MARETTA
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:24633 PEMBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3159
Mailing Address - Country:US
Mailing Address - Phone:248-755-5482
Mailing Address - Fax:313-286-3135
Practice Address - Street 1:25822 W 6 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2211
Practice Address - Country:US
Practice Address - Phone:313-286-3031
Practice Address - Fax:313-286-3135
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204426363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health