Provider Demographics
NPI:1972631307
Name:MOORE, ROBIN ELIZABETH
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ELIZABETH
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:145 LILLY RD NE STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5028
Mailing Address - Country:US
Mailing Address - Phone:369-459-9082
Mailing Address - Fax:360-459-4262
Practice Address - Street 1:145 LILLY RD NE STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5028
Practice Address - Country:US
Practice Address - Phone:369-459-9082
Practice Address - Fax:360-459-4262
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000416175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath