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Individual
MR. MATTHEW DAVID MOELLER
Active
Individual
MR. MATTHEW DAVID MOELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
28259150A
IN
363L00000X
Nurse Practitioner
Primary
71017118A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28259150A
RN LICENSE
IN
05
—
300121958
—
IN
Enumeration date
08/15/2025
Last updated
01/22/2026
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