Provider Demographics
NPI:1790221679
Name:MOULLET, VIRGINIA (ARNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MOULLET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:888 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3514
Mailing Address - Country:US
Mailing Address - Phone:509-946-4611
Mailing Address - Fax:509-942-2185
Practice Address - Street 1:560 GAGE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8650
Practice Address - Country:US
Practice Address - Phone:509-942-3627
Practice Address - Fax:509-942-2268
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60716569363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine