Provider Demographics
NPI:1245070374
Name:MOORE-STEPNITZ, MIRANDA S (MS)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:S
Last Name:MOORE-STEPNITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51920 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4453
Mailing Address - Country:US
Mailing Address - Phone:586-799-0949
Mailing Address - Fax:
Practice Address - Street 1:51920 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4453
Practice Address - Country:US
Practice Address - Phone:586-799-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist