Provider Demographics
NPI:1538937644
Name:MOSES, REBECCA MGBENKONYE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MGBENKONYE
Last Name:MOSES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ELLIOTT AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4236
Mailing Address - Country:US
Mailing Address - Phone:425-578-5144
Mailing Address - Fax:
Practice Address - Street 1:101 ELLIOTT AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4236
Practice Address - Country:US
Practice Address - Phone:425-578-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61678867363LP0808X
NC2023190554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health