Individual
VICTORIA A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
209 LILLY RD NE, OLYMPIA, WA 98506-5197
(360) 413-8250
(360) 413-8830
Mailing address
209 LILLY RD NE, OLYMPIA, WA 98506-5197
(360) 413-8250
(360) 413-8830
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA10003474
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA10003474
PA LISENCE
WA
Enumeration date
11/09/2005
Last updated
03/07/2023
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