Provider Demographics
NPI:1700635166
Name:MOSS, MILO LEVIKAI (RN)
Entity type:Individual
Prefix:
First Name:MILO
Middle Name:LEVIKAI
Last Name:MOSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-3701
Mailing Address - Country:US
Mailing Address - Phone:808-557-0440
Mailing Address - Fax:
Practice Address - Street 1:7602 BRIDGEPORT WAY W STE 2B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2415
Practice Address - Country:US
Practice Address - Phone:253-912-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61097335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse