Provider Demographics
NPI:1760690549
Name:MOFFITT, SHIRLEY JEAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 JILL MARIE ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-9619
Mailing Address - Country:US
Mailing Address - Phone:509-543-6511
Mailing Address - Fax:
Practice Address - Street 1:945 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3508
Practice Address - Country:US
Practice Address - Phone:509-943-5300
Practice Address - Fax:509-943-5331
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3006532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily