Provider Demographics
NPI:1699988626
Name:MOFFITT, LORISSA ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:LORISSA
Middle Name:ANN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 10TH AVE E APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4267
Mailing Address - Country:US
Mailing Address - Phone:425-308-3293
Mailing Address - Fax:
Practice Address - Street 1:1645 10TH AVE E APT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4267
Practice Address - Country:US
Practice Address - Phone:425-308-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002834171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist