Provider Demographics
NPI:1063862605
Name:MOBBLEY, MASHA (FNP)
Entity Type:Individual
Prefix:
First Name:MASHA
Middle Name:
Last Name:MOBBLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ALEXANDROVNA
Other - Last Name:NAZOROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24325
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0325
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-385-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8761363L00000X
WAAP61090484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner