Individual
COURTNEY G MOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
950 CAMPBELL AVE, GEC240, WEST HAVEN, CT 06516-2770
(203) 932-5711
Mailing address
950 CAMPBELL AVE, GEC 240, WEST HAVEN, CT 06516-2770
(203) 932-5711
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002124
LICENSE
CT
01
—
PA3371
LICENSE
MA
Enumeration date
08/22/2008
Last updated
10/12/2011
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