Provider Demographics
NPI:1205173572
Name:MOINEAU, RUTH M (NURSE PRACTITONER)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:MOINEAU
Suffix:
Gender:F
Credentials:NURSE PRACTITONER
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Mailing Address - Street 1:4201 ST. ANTOINE UHC 5D
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-5051
Practice Address - Street 1:3950 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI/ SPECIALTY CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-832-8550
Practice Address - Fax:313-993-8685
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704191752363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics