Individual
MRS. CARISSA MOMENT X
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(402) 995-3499
Mailing address
3516 N 47TH AVE, OMAHA, NE 68104-3630
(402) 889-8790
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P49486
IA
Other
Enumeration date
10/23/2016
Last updated
10/23/2016
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