Provider Demographics
NPI:1255890638
Name:MOOTH, AUDRIANA LORAINE (DO)
Entity type:Individual
Prefix:
First Name:AUDRIANA
Middle Name:LORAINE
Last Name:MOOTH
Suffix:
Gender:F
Credentials:DO
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 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:
Practice Address - Street 1:1455 NW LEARY WAY STE 350
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5140
Practice Address - Country:US
Practice Address - Phone:206-668-6100
Practice Address - Fax:206-668-6101
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61533074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine