Provider Demographics
NPI:1407568694
Name:MORES, KAUI O NOHEA
Entity Type:Individual
Prefix:
First Name:KAUI O NOHEA
Middle Name:
Last Name:MORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 132ND ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9517
Mailing Address - Country:US
Mailing Address - Phone:425-357-6162
Mailing Address - Fax:
Practice Address - Street 1:5006 132ND ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9517
Practice Address - Country:US
Practice Address - Phone:425-357-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61338741183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0333520067Medicaid