Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP30006758 | WA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP30006758 | WA |
NPI | 1063440964 |
---|---|
Provider Name | Ms. Tammy H. Moore |
First Address | Elma, WA 98541 |
Second Address | Elma, WA 98541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 17/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0159113 | LABOR AND INDUSTRIES# (01) | WA |
1090710 | (05) | WA |
9644014 | DSHS# (01) | WA |
MD1136313 | DEA# (01) | WA |
Q47544 | (02) | WA |