Individual
SULLY MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IP
Contact information
Practice address
1410 N CAUFIELD CT, LIBERTY LAKE, WA 99016-9433
(360) 525-5996
Mailing address
1410 N CAUFIELD CT, LIBERTY LAKE, WA 99016-9433
(360) 525-5996
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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