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NPI Code Detail

MEDICARE: MS. MAURA LEE MUZZALL-MOORE PAC

MEDICARE: MS. MAURA LEE MUZZALL-MOORE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA10000002975WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18931006OTHERWACRIME VICTIM COMPENSATION
25530MUOTHERWAASURIS INSURANCE CO,
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40176649OTHERWAWORKERS COMPENSATION

General Provider Information

NPI Number : 1730139320
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAURA LEE MUZZALL-MOORE PAC
Provider Business Mailing Address
First Line : PO BOX 3188
Second Line :
City : OMAK
State : WA
Zip : 98841-3188
Country : US
Telephone Number : 509-826-1600
Fax Number : 509-826-3633
Provider Business Practice Location Address
First Line : 529 JASMINE ST
Second Line :
City : OMAK
State : WA
Zip : 98841-9589
Country : US
Telephone Number : 529-826-1600
Fax Number : 509-826-3633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/08/2007

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1164409637 — MR. GREGORY D FISK PAC
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OMAK, WA
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1184697054 — DR. DEAN R QUIGLEY MD
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OMAK, WA
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1578525762 — PAUL B MYERS MD
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1255381836 — MRS. STELLA DELORES DOLGNER A.R.N.P.
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