Individual
LARAINE YAKOWICH MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3901 BEAUBIEN, CHILDREN'S HOSPITAL OF MI, DETROIT, MI 48201
(313) 745-5481
(313) 993-0894
Mailing address
4201 ST. ANTOINE - UHC 5D MAILBOX #226, UNIVERSITY PEDIATRICIANS, DETROIT, MI 48201-2153
(313) 745-4405
(313) 966-0665
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704110337
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704110337
MI
Other
Enumeration date
07/03/2006
Last updated
01/17/2017
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