Healthcare Provider Details

I. General information

NPI: 1881966000
Provider Name (Legal Business Name): CARA MOELLER FNP, CDE, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HIGH ST
MIDDLETOWN RI
02842-4920
US

IV. Provider business mailing address

450 VETERANS MEMORIAL PKWY BLDG 10
EAST PROVIDENCE RI
02914-5300
US

V. Phone/Fax

Practice location:
  • Phone: 860-463-0176
  • Fax:
Mailing address:
  • Phone: 401-438-6888
  • Fax: 401-434-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN45450
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01686
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: