Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1114690807 |
---|---|
Provider Name | Brittany Megan Moores |
First Address | Olympia, WA 98501-8204 |
Second Address | Olympia, WA 98506-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |