Provider Demographics
NPI:1750864187
Name:MOH, BRINA RAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRINA
Middle Name:RAYNE
Last Name:MOH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRINA
Other - Middle Name:RAYNE
Other - Last Name:SYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3211 H ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2745
Mailing Address - Country:US
Mailing Address - Phone:360-852-7277
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-501-3500
Practice Address - Fax:360-501-3555
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.60996167363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical