Provider Demographics
NPI:1770582884
Name:MOLLER, MARY D (DNP, APRN, PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:D
Last Name:MOLLER
Suffix:
Gender:F
Credentials:DNP, APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARY D. MOLLER
Mailing Address - Street 2:14702 41ST AVE CT NW
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-2471
Mailing Address - Country:US
Mailing Address - Phone:203-747-5667
Mailing Address - Fax:
Practice Address - Street 1:5929 WESTGATE BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2567
Practice Address - Country:US
Practice Address - Phone:253-200-0415
Practice Address - Fax:253-625-7912
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003075364SP0809X
CT004003364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004003OtherAPRN LICENSE
WAAP30003075OtherARNP LIC #
319000011Medicare ID - Type UnspecifiedINDIVIDUAL
R31862Medicare UPIN