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General NPI Number Information
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NPI Number | 1801618152
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Entity Type | Individual
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Provider Name | SUSAN MARIE MOORE CCSH, RPSGT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2000 HOSPITAL DR
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-4327
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Country | US
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Telephone | 360-856-7514
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Fax | 360-856-7515
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Provider Business Mailing Address
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Address Line | 4029 MORGAN RD
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City | SUMAS
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State | WA
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Zip | 98295-8804
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Country | US
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Telephone | 716-870-5591
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 1399
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License Number State |
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