Provider Demographics
NPI:1184498925
Name:MOOERS, ERIN MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MOOERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HUDSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2931
Mailing Address - Country:US
Mailing Address - Phone:360-504-0122
Mailing Address - Fax:360-859-1354
Practice Address - Street 1:1700 HUDSON ST STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2931
Practice Address - Country:US
Practice Address - Phone:360-504-0122
Practice Address - Fax:360-859-1354
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201330085LPN164W00000X
WALP61243540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse