Individual
WENNIE MAE AGBALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1309 SW 25TH ST, MOORE, OK 73170-7558
(952) 393-6271
Mailing address
1309 SW 25TH ST, MOORE, OK 73170-7558
(952) 393-6271
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/27/2025
Last updated
09/09/2025
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