Basic Information
| Provider Information | |||||||||
| NPI: | 1871212928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOELLER | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12400 E CAPE HORN DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857498488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203072012 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5301 E GRANT RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203275461 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2022 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95260559 | CA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN2353354 | MA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN60856061 | WA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 219778 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.