Provider Demographics
NPI:1770728156
Name:MOSBY, ASHANTI RENEE (LMP)
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:RENEE
Last Name:MOSBY
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 1:365 RENTON CENTER WAY SW
Mailing Address - Street 2:#F
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2324
Mailing Address - Country:US
Mailing Address - Phone:425-226-7061
Mailing Address - Fax:425-226-7063
Practice Address - Street 1:365 RENTON CENTER WAY SW
Practice Address - Street 2:#F
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2324
Practice Address - Country:US
Practice Address - Phone:425-226-7061
Practice Address - Fax:425-226-7063
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist