Individual
MARISSA ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
75 DE SMET DR, FLORISSANT, MO 63031-8404
(314) 348-1629
Mailing address
75 DE SMET DR, FLORISSANT, MO 63031-8404
(314) 348-1629
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234567590
—
MO
Enumeration date
01/05/2022
Last updated
01/05/2022
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