Provider Demographics
NPI:1619388147
Name:MOFFAT, ANNE (LM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9222 FLETCHER BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1662
Mailing Address - Country:US
Mailing Address - Phone:206-251-7604
Mailing Address - Fax:
Practice Address - Street 1:9222 FLETCHER BAY RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1662
Practice Address - Country:US
Practice Address - Phone:206-251-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000167176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife