Individual
EBONY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4301 WILSON ST, FT. SILL, OK 73503
(580) 558-2662
Mailing address
4824 NW HOOVER AVE, LAWTON, OK 73505-1631
(910) 670-8980
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0038603
OK
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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