Healthcare Provider Details

I. General information

NPI: 1447250410
Provider Name (Legal Business Name): MOLLER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5998 HIGHWAY 291 #5
NINE MILE FALLS WA
99026-9573
US

IV. Provider business mailing address

13013 W SUNNYVALE DR
NINE MILE FALLS WA
99026-9319
US

V. Phone/Fax

Practice location:
  • Phone: 509-468-4770
  • Fax: 509-468-4659
Mailing address:
  • Phone: 509-468-4770
  • Fax: 509-468-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY DENISE MOLLER
Title or Position: CLINICAL DIRECTOR
Credential: MSN, ARNP, BC, ND(C)
Phone: 509-468-4770