Individual
SHANDA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 588-2662
Mailing address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 588-2662
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
Primary
0096640
OK
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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