MEDICARE: MOLLER ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1447250410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLLER ENTERPRISES INC

Provider Business Mailing Address
First Line	:	13013 W SUNNYVALE DR
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-9319
Country	:	US
Telephone Number	:	509-468-4770
Fax Number	:	509-468-4659

Provider Business Practice Location Address
First Line	:	5998 HIGHWAY 291
Second Line	:	#5
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-9573
Country	:	US
Telephone Number	:	509-468-4770
Fax Number	:	509-468-4659

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/22/2020

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Directions to “MOLLER ENTERPRISES INC ” Practice Location

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