Sully Moon, IP
Sully Moon, IP is an Attendant Care Provider in Liberty Lake, Washington. Practices as a sole proprietor. Registered with an NPI since 2022.
- In the registry since
- 2022
Practice location Address checks out
1410 N Caufield CtLiberty Lake, WA 99016-9433
Phone: (360) 525-5996
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Attendant Care Provider (primary) | Taxonomy 3747A0650X |
|---|
Record details
| NPI number | 1982326914 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | IP |
| Sole proprietor | Yes |
| NPI enumerated | September 15, 2022 |
| Last updated in NPPES | September 15, 2022 |
| Certification date | September 15, 2022 |
| Mailing address | 1410 N Caufield Ct, Liberty Lake, WA 99016-9433 |
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