Provider Demographics
NPI:1255699021
Name:MORA, CAROLYN ANN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:MORA
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 1:17940 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:NEW LOTHROP
Mailing Address - State:MI
Mailing Address - Zip Code:48460-9641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17940 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:NEW LOTHROP
Practice Address - State:MI
Practice Address - Zip Code:48460-9641
Practice Address - Country:US
Practice Address - Phone:989-845-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator