Provider Demographics
NPI:1992830640
Name:GEBHARD, MORIA LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:MORIA
Middle Name:LYNN
Last Name:GEBHARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 ALLEN LN
Mailing Address - Street 2:
Mailing Address - City:PESHASTIN
Mailing Address - State:WA
Mailing Address - Zip Code:98847-9426
Mailing Address - Country:US
Mailing Address - Phone:509-548-0712
Mailing Address - Fax:
Practice Address - Street 1:620 N EMERSON AVE
Practice Address - Street 2:STE 201
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-663-5420
Practice Address - Fax:509-664-7372
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist