Provider Demographics
NPI:1437730199
Name:MOELLER, LISA M (LACTATION CONSULTANT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MOELLER
Suffix:
Gender:F
Credentials:LACTATION CONSULTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32649 WOLFS TRL
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-7816
Mailing Address - Country:US
Mailing Address - Phone:352-552-2025
Mailing Address - Fax:
Practice Address - Street 1:32649 WOLFS TRL
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-7816
Practice Address - Country:US
Practice Address - Phone:352-552-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9384206163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant