Individual
CASSIDY MOONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1045 NW BOND ST, BEND, OR 97703-2043
(541) 610-4291
Mailing address
1147 NE VIKING CT, BEND, OR 97701-3961
(541) 610-4291
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
10096
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20150413
EBMS
—
Enumeration date
03/11/2016
Last updated
03/11/2016
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