| Doctor Name: | SHANDA MOORE |
| NPI Number: | 1407204373 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0096640 |
| Business Practice Address: | 4301 Wilson St Fort Sill, OK - 735034472 |
| Business Phone Number: | 5805882662 |
| Business Fax Number: | |
| Mailing Address: | 4301 Wilson St, FORT SILL |
| State: | OK |
| Postal Code: | 735034472 |
| Phone Number: | 5805882662 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2016 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WX0003X |
| License Number: | 0096640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Obstetric, Inpatient |
| Taxonomy Definition: | |