Individual
SHANNON L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1235 3RD STREET, SEDRO-WOOLLEY, WA 98284
(360) 855-3510
Mailing address
1235 3RD STREET, SEDRO-WOOLLEY, WA 98284
(360) 855-3510
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00054619
WA
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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