Provider Demographics
NPI:1972386084
Name:MOUSSA, REEMA NAWALL
Entity type:Individual
Prefix:
First Name:REEMA
Middle Name:NAWALL
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W MAIN ST APT 523
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7919
Mailing Address - Country:US
Mailing Address - Phone:316-737-8395
Mailing Address - Fax:
Practice Address - Street 1:913 W MAIN ST APT 523
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7919
Practice Address - Country:US
Practice Address - Phone:316-737-8395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program