Basic Information
| Provider Information | |||||||||
| NPI: | 1073947008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSES | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6227 FRANKFORT HWY | ||||||||
| Address2: | |||||||||
| City: | BENZONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496168632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318829661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496639429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318244100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 5601006735 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.