Provider Demographics
NPI:1154016855
Name:MOORE, EVA NDUTA (RN)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:NDUTA
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8318 MAYBELLE LN SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3626
Mailing Address - Country:US
Mailing Address - Phone:253-260-8997
Mailing Address - Fax:
Practice Address - Street 1:8318 MAYBELLE LN SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3626
Practice Address - Country:US
Practice Address - Phone:253-260-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60947400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse