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General NPI Number Information
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NPI Number | 1093995342
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Entity Type | Individual
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Provider Name | JENNIFER MARIE MOELLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2007
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 984120 NEBRASKA MEDICAL CTR
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City | OMAHA
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State | NE
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Zip | 68198-4120
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Country | US
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Telephone | 402-559-2958
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Fax | 402-559-9003
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Provider Business Mailing Address
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Address Line | 984120 NEBRASKA MEDICAL CTR
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City | OMAHA
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State | NE
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Zip | 68198-4120
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Country | US
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Telephone | 402-559-2958
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Fax | 402-559-9003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1255
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License Number State | NE
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