Provider Demographics
NPI:1447250410
Name:MOLLER ENTERPRISES INC
Entity type:Organization
Organization Name:MOLLER ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ARNP, BC, ND(C)
Authorized Official - Phone:509-468-4770
Mailing Address - Street 1:13013 W SUNNYVALE DR
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9319
Mailing Address - Country:US
Mailing Address - Phone:509-468-4770
Mailing Address - Fax:509-468-4659
Practice Address - Street 1:5998 HIGHWAY 291
Practice Address - Street 2:#5
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9573
Practice Address - Country:US
Practice Address - Phone:509-468-4770
Practice Address - Fax:509-468-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center