Provider Demographics
NPI:1932377397
Name:MOAT, CHELLE LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELLE
Middle Name:LYNNE
Last Name:MOAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 REED ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1146
Mailing Address - Country:US
Mailing Address - Phone:360-855-2627
Mailing Address - Fax:
Practice Address - Street 1:310 REED ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1146
Practice Address - Country:US
Practice Address - Phone:360-855-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine