Provider Demographics
NPI:1881899185
Name:MOODY, MICHELLE SHEILA (LMP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SHEILA
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:SHEILA
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:1381 N SHORE DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-8366
Mailing Address - Country:US
Mailing Address - Phone:509-671-2541
Mailing Address - Fax:
Practice Address - Street 1:1381 N SHORE DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-8366
Practice Address - Country:US
Practice Address - Phone:509-671-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012560175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath