Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA00012560 | WA |
NPI | 1881899185 |
---|---|
Provider Name | Mrs. Michelle Sheila Moody |
First Address | Newport, WA 99156-8366 |
Second Address | Newport, WA 99156-8366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 24/03/2016 |