Individual
MARY MAUDEANA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5190
(701) 723-5391
Mailing address
130 RIVER RD APT E207, MUSCLE SHOALS, AL 35661-1338
(918) 661-6180
(256) 325-6724
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-117717
AL
363LF0000X
Family Nurse Practitioner
114792
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200558940A
—
OK
Enumeration date
10/01/2014
Last updated
11/06/2023
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