Healthcare Provider Details

I. General information

NPI: 1699007195
Provider Name (Legal Business Name): MISS EMILY FAITH MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. EMILY FAITH JACKSON

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S G0035
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M/S G0035
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-6442
  • Fax: 206-987-3839
Mailing address:
  • Phone: 206-987-6442
  • Fax: 206-987-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60120443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: