Provider Demographics
NPI:1427826478
Name:MOATS, ANNETTE M
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:MOATS
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 1:99 BOBS WAY RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:WV
Mailing Address - Zip Code:26705-8642
Mailing Address - Country:US
Mailing Address - Phone:304-698-4719
Mailing Address - Fax:
Practice Address - Street 1:99 BOBS WAY RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:WV
Practice Address - Zip Code:26705-8642
Practice Address - Country:US
Practice Address - Phone:304-698-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker