| Ebanysangel | |
|
726 Penn Ivy St Moses Lake WA 98837-2790 | |
| (509) 864-0860 | |
| Not Available |
| Full Name | Ebanysangel |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 726 Penn Ivy St, Moses Lake, Washington |
| Authorized Official Name and Position | Nichole Lynn Nolan (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5098640860 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebanysangel Po Box 97 Moses Lake WA 98837-0016 Ph: (509) 864-0860 | Ebanysangel 726 Penn Ivy St Moses Lake WA 98837-2790 Ph: (509) 864-0860 |
| NPI Number | 1952125809 |
|---|---|
| Provider Enumeration Date | 11/07/2024 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952125809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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