# MR. MATTHEW DAVID MOELLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1790661411
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC0200X | Critical Care Medicine Registered Nurse | 28259150A | IN | Yes |
| 363L00000X | Nurse Practitioner | 71017118A | IN | Yes |

## Other

- **Enumeration date:** 08/15/2025
- **Last updated:** 01/22/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 28259150A | RN LICENSE | IN |
| 05 | — | 300121958 | — | IN |