Provider Demographics
NPI:1467238246
Name:SULICH-MOORE, CAROLINE ELENA (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELENA
Last Name:SULICH-MOORE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1964
Mailing Address - Country:US
Mailing Address - Phone:248-914-2584
Mailing Address - Fax:
Practice Address - Street 1:11900 E 12 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3490
Practice Address - Country:US
Practice Address - Phone:586-574-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily