Provider Demographics
NPI:1306177514
Name:MOREAU, MICHEL PIERRE (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:PIERRE
Last Name:MOREAU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31831 WOODBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2790
Mailing Address - Country:US
Mailing Address - Phone:440-371-7376
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # 31
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8658
Practice Address - Fax:216-444-9247
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 308471-COA1282N00000X
OHCOA 11312-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No282N00000XHospitalsGeneral Acute Care Hospital