Individual
SANDRA M MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2205 W LINCOLN AVE, YAKIMA, WA 98902-2437
(509) 469-6305
(509) 575-3398
Mailing address
2205 W LINCOLN AVE, YAKIMA, WA 98902-2437
(509) 469-6305
(509) 575-3398
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13906
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0101240
—
CA
05
—
GR0101241
—
CA
05
—
GR0101242
—
CA
01
—
ZZZ27958Z
MEDICARE GROUP ID
CA
Enumeration date
05/24/2007
Last updated
03/11/2022
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