Provider Demographics
NPI:1265115885
Name:MORAN, MICHELLE RENEA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEA
Last Name:MORAN
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 1:2170 N MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26410-8996
Mailing Address - Country:US
Mailing Address - Phone:304-892-4424
Mailing Address - Fax:
Practice Address - Street 1:2170 N MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:NEWBURG
Practice Address - State:WV
Practice Address - Zip Code:26410-8996
Practice Address - Country:US
Practice Address - Phone:304-892-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant