Healthcare Provider Details

I. General information

NPI: 1881899185
Provider Name (Legal Business Name): MICHELLE SHEILA MOODY L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE SHEILA MOODY L.M.P.

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 N SHORE DIAMOND LAKE RD
NEWPORT WA
99156-8366
US

IV. Provider business mailing address

1381 N SHORE DIAMOND LAKE RD
NEWPORT WA
99156-8366
US

V. Phone/Fax

Practice location:
  • Phone: 509-671-2541
  • Fax:
Mailing address:
  • Phone: 509-671-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA00012560
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: