Provider Demographics
NPI:1689360364
Name:MORALES NICASIO, MONSERRAT
Entity Type:Individual
Prefix:
First Name:MONSERRAT
Middle Name:
Last Name:MORALES NICASIO
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 1:1325 OLYMPIC HWY S
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3235
Mailing Address - Country:US
Mailing Address - Phone:360-277-8746
Mailing Address - Fax:
Practice Address - Street 1:23291 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9324
Practice Address - Country:US
Practice Address - Phone:360-763-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61431660171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator