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Sully Moon, IP
Attendant Care Provider in Liberty Lake, Washington
NPI 1982326914

Sully Moon is an Attendant Care Provider based in Liberty Lake, WA and is specialized in Attendant Care Provider. Sully Moon practices in Liberty Lake, WA and has the professional credentials of IP. The NPI Number for Sully Moon is 1982326914 and holds a License No. (Washington).

The current practice location address for Sully Moon is 1410 N Caufield Ct, Liberty Lake, WA and can be reached out via phone at 360-525-5996.

Location: 1410 N Caufield Ct, Liberty Lake, WA, 99016-9433
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1982326914
Provider Name
Sully Moon
Credential
IP
Provider Entity Type
Individual
Gender
Male
Address
1410 N Caufield Ct, Liberty Lake, WA, 99016-9433
Phone Number
360-525-5996
Fax Number
Provider Enumeration Date
09/15/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1410 N Caufield Ct
City
Liberty Lake
State
Washington
Zip
99016-9433
Phone Number
360-525-5996
Fax Number
person
Provider Business Mailing Address Details
Address
1410 N Caufield Ct
City
Liberty Lake
State
Washington
Zip
99016-9433
Phone Number
360-525-5996
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing Service Related Providers
Classification
Technician
Speciality
Attendant Care Provider
Taxonomy
3747A0650X
License No.
()
Definition
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law.
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