Provider Demographics
NPI:1699007195
Name:MOORE, EMILY FAITH
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:FAITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:FAITH
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S G0035
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-6442
Mailing Address - Fax:206-987-3839
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S G0035
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-6442
Practice Address - Fax:206-987-3839
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60120443363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics