Individual
ANDREA MOSKONAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
601 WHISKEY CREEK RD, WALLOWA, OR 97885-7129
(541) 886-3142
Mailing address
PO BOX 268, ENTERPRISE, OR 97828-0268
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201390804RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201390804RN
OREGON STATE BOARD OF NURSING
OR
Enumeration date
03/26/2019
Last updated
03/26/2019
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