Provider Demographics
NPI:1922780451
Name:MOYER, LIA MICHELLE (DNP, AGACNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:MICHELLE
Last Name:MOYER
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC, RN
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:
Other - Last Name:GRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2119 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5753
Mailing Address - Country:US
Mailing Address - Phone:864-238-4357
Mailing Address - Fax:
Practice Address - Street 1:900 COOPER AVE STE 3100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319599363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care