Provider Demographics
NPI:1164081576
Name:MOORE, CASSANDRA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 SEABECK HOLLY RD NW UNIT 835
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-4034
Mailing Address - Country:US
Mailing Address - Phone:360-620-6546
Mailing Address - Fax:
Practice Address - Street 1:3863 SEABECK HOLLY RD NW
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-9227
Practice Address - Country:US
Practice Address - Phone:360-620-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0012475163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health