Provider Demographics
NPI:1073079141
Name:MOSS, DANIELLE MARIE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E LUELLEN RD
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-9524
Mailing Address - Country:US
Mailing Address - Phone:405-542-2278
Mailing Address - Fax:
Practice Address - Street 1:112 E LUELLEN RD
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047-9524
Practice Address - Country:US
Practice Address - Phone:405-542-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily