Healthcare Provider Details

I. General information

NPI: 1053519215
Provider Name (Legal Business Name): MANOSHI VIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 112TH AVE NE 240W
BELLEVUE WA
98004-2993
US

IV. Provider business mailing address

15127 NE 24TH ST UNIT 83
REDMOND WA
98052-5544
US

V. Phone/Fax

Practice location:
  • Phone: 425-298-6535
  • Fax:
Mailing address:
  • Phone: 425-298-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: