Provider Demographics
NPI:1619520046
Name:MWAURA, MOSES
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:MWAURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11232 SE 315TH CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-5390
Mailing Address - Country:US
Mailing Address - Phone:626-200-6603
Mailing Address - Fax:
Practice Address - Street 1:11232 SE 315TH CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-5390
Practice Address - Country:US
Practice Address - Phone:626-200-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60670844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse