Healthcare Provider Details

I. General information

NPI: 1700635166
Provider Name (Legal Business Name): MILO LEVIKAI MOSS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3933
US

IV. Provider business mailing address

4302 S J ST
TACOMA WA
98418-3701
US

V. Phone/Fax

Practice location:
  • Phone: 800-769-0045
  • Fax:
Mailing address:
  • Phone: 808-557-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61681478
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61097335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: