Provider Demographics
NPI:1669254017
Name:MOYE, KHADIJAH BRIANA
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:BRIANA
Last Name:MOYE
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 1:5623 E HICKORY HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2615
Mailing Address - Country:US
Mailing Address - Phone:734-780-9623
Mailing Address - Fax:
Practice Address - Street 1:5623 E HICKORY HOLLOW ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2615
Practice Address - Country:US
Practice Address - Phone:734-780-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MIMI09262023137984376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide