Provider Demographics
NPI:1386413011
Name:MOREAU, CORRIE LA RISSA (RN, MSN, CRNI, VA-BC)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:LA RISSA
Last Name:MOREAU
Suffix:
Gender:F
Credentials:RN, MSN, CRNI, VA-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13036 SE KENT KANGLEY RD # 265
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7965
Mailing Address - Country:US
Mailing Address - Phone:253-326-6898
Mailing Address - Fax:
Practice Address - Street 1:10511 SE 250TH PL # E101
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2888
Practice Address - Country:US
Practice Address - Phone:253-326-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60673899163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy