Individual
ETHAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
9707 NINA ST, OMAHA, NE 68124-3750
(308) 991-6136
Mailing address
9707 NINA ST, OMAHA, NE 68124-3750
(308) 991-6136
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/10/2025
Last updated
10/10/2025
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