Provider Demographics
NPI:1891519161
Name:MOORE, ANGELA E (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:MOORE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:EVON
Other - Last Name:UREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2016 HAGADORN RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9414
Mailing Address - Country:US
Mailing Address - Phone:915-471-4665
Mailing Address - Fax:
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-742-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine