Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | MD00041718 | WA |
NPI | 1225027436 |
---|---|
Provider Name | Stephanie Rose Moline |
First Address | Spokane, WA 99220-3868 |
Second Address | Spokane, WA 99202-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 24/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010140846 | BLUE SHIELD OF IDAHO (01) | |
0164026 | LABOR & INDUSTRIES (01) | WA |
7631MO | ASURIS NW HEALTH (01) | |
7744005 | AETNA (01) | |
806453700 | (05) | ID |
8322315 | (05) | WA |
910000395 | RAILROAD MEDICARE (01) | |
G19001 | (02) | |
KS665 | BLUE CROSS OF IDAHO (01) |