Provider Demographics
NPI:1780380667
Name:MOORE, EVELYN MARIE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:MARIE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 LILLY RD NE APT K6
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5020
Mailing Address - Country:US
Mailing Address - Phone:515-601-1518
Mailing Address - Fax:
Practice Address - Street 1:908 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1507
Practice Address - Country:US
Practice Address - Phone:360-549-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist