Provider Demographics
NPI:1467686568
Name:MOORE, ERIN DE ANN (CNA)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:DE ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 S 112TH ST
Mailing Address - Street 2:#B-201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168
Mailing Address - Country:US
Mailing Address - Phone:206-779-4122
Mailing Address - Fax:
Practice Address - Street 1:2225 S 112TH ST
Practice Address - Street 2:#B-201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168
Practice Address - Country:US
Practice Address - Phone:206-779-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10099863376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide