Provider Demographics
NPI:1760744775
Name:MOSELEY, MICHELE L (FNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3201
Mailing Address - Country:US
Mailing Address - Phone:509-665-6087
Mailing Address - Fax:509-665-6161
Practice Address - Street 1:1215 S MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3201
Practice Address - Country:US
Practice Address - Phone:509-665-6087
Practice Address - Fax:509-665-6161
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60285159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0295959OtherL & I
WAP01410336OtherRR MEDICARE
WA1760744775Medicaid
WA0295959OtherL & I
WAG8910400Medicare PIN