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Individual

MONTE DALE MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
401 E VAUGHN AVE, RUSTON, LA 71270-5950
(318) 224-7190
Mailing address
PO BOX 1288, WINNFIELD, LA 71483-1288
(318) 224-7190

Taxonomy

Speciality
Code
Description
License number
State
364SP0810X
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
Primary
203896
LA

Other

Enumeration date
03/11/2019
Last updated
06/26/2019
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