Provider Demographics
NPI:1083197677
Name:MOFOR, FRANCA MOMA
Entity type:Individual
Prefix:
First Name:FRANCA
Middle Name:MOMA
Last Name:MOFOR
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 1:42843 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2945
Mailing Address - Country:US
Mailing Address - Phone:248-819-0945
Mailing Address - Fax:
Practice Address - Street 1:42843 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2945
Practice Address - Country:US
Practice Address - Phone:248-819-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily