Basic Information
| Provider Information | |||||||||
| NPI: | 1699358416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOE | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | |||||||||
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| Credential: | NBHWC, ACC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14868 6TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981556950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064122256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13123 121ST WAY NE STE D | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064701925 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2021 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171400000X | Y |
No ID Information.