Provider Demographics
NPI:1497857015
Name:MOORE, SEANA M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SEANA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 TIETON DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3684
Mailing Address - Country:US
Mailing Address - Phone:509-248-3440
Mailing Address - Fax:509-452-1648
Practice Address - Street 1:3003 TIETON DR
Practice Address - Street 2:SUITE 230
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3684
Practice Address - Country:US
Practice Address - Phone:509-248-3440
Practice Address - Fax:509-452-1648
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142455363L00000X
WAP30007145363L00000X
WAAP30007145363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q62116Medicare UPIN
8858218Medicare ID - Type Unspecified