Individual
CHASA NICOLE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(888) 537-7792
Mailing address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(888) 537-7792
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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