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General NPI Number Information
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NPI Number | 1689360364
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Entity Type | Individual
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Provider Name | MONSERRAT MORALES NICASIO
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Gender | Female
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 23291 NE STATE ROUTE 3
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City | BELFAIR
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State | WA
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Zip | 98528-9324
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Country | US
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Telephone | 360-763-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 OLYMPIC HWY S
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City | SHELTON
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State | WA
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Zip | 98584-3235
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Country | US
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Telephone | 360-277-8746
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CG61431660
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License Number State | WA
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