Provider Demographics
NPI:1609433218
Name:MOELLER, CHARLENE J (RN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:J
Last Name:MOELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1387
Mailing Address - Country:US
Mailing Address - Phone:307-763-8701
Mailing Address - Fax:
Practice Address - Street 1:110 S GOULD ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6321
Practice Address - Country:US
Practice Address - Phone:307-673-8701
Practice Address - Fax:307-224-2293
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse