Sully Moon, IP
NPI #1982326914 in Liberty Lake, Washington
Provider Information
- NPI Number
- 1982326914
- Entity Type
- Individual
- Name
- Sully Moon, IP
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Technician - Attendant Care Provider
- Credential
- IP
- Enumeration Date
- Sep 15, 2022
- Last Updated
- Sep 15, 2022
Practice Location
- Address
- 1410 N CAUFIELD CT
- City
- Liberty Lake
- State
- Washington
- ZIP Code
- 99016-9433
- Phone
- (360) 525-5996
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician - Attendant Care Provider — Attendant Care Provider |
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