Provider Demographics
NPI:1972813798
Name:MOSES, WANDA ATTLA
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:ATTLA
Last Name:MOSES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:AK
Mailing Address - Zip Code:99741-0017
Mailing Address - Country:US
Mailing Address - Phone:907-656-1366
Mailing Address - Fax:907-656-1581
Practice Address - Street 1:17 ANTOSKI AVE.
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741-0017
Practice Address - Country:US
Practice Address - Phone:907-656-1366
Practice Address - Fax:907-656-1581
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)