Individual
AMANDA LEEANN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GED
Contact information
Practice address
215 NE 1ST ST, WAGONER, OK 74467-4439
(918) 201-4333
Mailing address
605 N POLK AVE, WAGONER, OK 74467-2713
(918) 284-2513
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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