Active NPI
Brandie Lee Moon, RDH
- Dental Hygienist
- Chehalis, WA
National Provider Identifier
1861885253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH 60069688
- Practice address
- 2690 NE Kresky Ave
Chehalis, WA 98532-2412 - Phone
- (360) 330-9595
- Fax
- (360) 330-9560
- NPI assigned
- Mar 10, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH 60069688 | WA | Primary |
Addresses
Primary practice location
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Mailing address
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH 60069688 | WA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426032000000",
"number": "1861885253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2690 NE KRESKY AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985322412",
"telephone_number": "360-330-9595",
"fax_number": "360-330-9560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2690 NE KRESKY AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985322412",
"telephone_number": "360-330-9595",
"fax_number": "360-330-9560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "BRANDIE",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-10",
"last_updated": "2015-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WA",
"license": "DH 60069688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.