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General NPI Number Information
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NPI Number | 1144580218
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Entity Type | Individual
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Provider Name | SHENG MOUA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 1104 MAIN ST SUITE M105
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City | VANCOUVER
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State | WA
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Zip | 98660-2999
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Country | US
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Telephone | 360-450-3889
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Fax | 360-450-3887
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Provider Business Mailing Address
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Address Line | 317 SW 37TH TER
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City | GRESHAM
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State | OR
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Zip | 97080-8441
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Country | US
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Telephone | 971-285-6745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60261701
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License Number State | WA
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