Provider Demographics
NPI:1972386027
Name:FLAGLER, MORIAH
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:FLAGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIAH
Other - Middle Name:
Other - Last Name:FLAGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-0816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15315 1ST AVE NE STE 216
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-5005
Practice Address - Country:US
Practice Address - Phone:425-780-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program