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General NPI Number Information
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NPI Number | 1144167529
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Entity Type | Organization
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Legal Business Name | MOONLIGHT ELECTROLYSIS LLC
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 1505 E PORTLAND RD STE 206
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City | NEWBERG
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State | OR
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Zip | 97132-1852
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Country | US
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Telephone | 971-258-0035
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Fax |
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Provider Business Mailing Address
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Address Line | 904 NW YAMHILL ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-5061
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Country | US
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Telephone | 971-258-0035
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MARK KENNETH SMITH
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Credential | LE
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Telephone | 971-258-0035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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