Individual
PAULA RENEE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1550 S PIONEER WAY STE 100, MOSES LAKE, WA 98837
(509) 793-9790
(509) 764-3255
Mailing address
660 S COOLIDGE ST, MOSES LAKE, WA 98837-1872
(509) 793-9715
(509) 764-3244
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10130700-1206
UT
363A00000X
Physician Assistant
2019015462
MO
363A00000X
Physician Assistant
5886
AZ
363A00000X
Physician Assistant
Primary
PA60342285
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2130702
—
WA
Enumeration date
05/05/2006
Last updated
07/08/2022
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