Provider Demographics
NPI:1225748510
Name:MOELLER, KARIN (OMD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4781 CLOVER RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8423
Mailing Address - Country:US
Mailing Address - Phone:904-955-0786
Mailing Address - Fax:
Practice Address - Street 1:5594 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3611
Practice Address - Country:US
Practice Address - Phone:702-763-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist