Provider Demographics
NPI:1194129080
Name:MOLDOVAN, SEMIDA
Entity type:Individual
Prefix:
First Name:SEMIDA
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 240TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9040
Mailing Address - Country:US
Mailing Address - Phone:425-487-9373
Mailing Address - Fax:425-487-9373
Practice Address - Street 1:4613 240TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9040
Practice Address - Country:US
Practice Address - Phone:425-487-9373
Practice Address - Fax:425-487-9373
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA480400310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility