Individual
MS. MARY P MOELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
425 N 30TH ST, OMAHA, NE 68131-2100
(402) 452-5000
(402) 452-5028
Mailing address
555 N 30TH ST, OMAHA, NE 68131-2136
(402) 280-8100
(402) 280-8103
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
43
NE
237700000X
Hearing Instrument Specialist
43
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0586982
—
IA
01
—
06606
BCBS BT
NE
01
—
06610
BCBS ENT
NE
05
—
100251703-00
—
NE
05
—
100251704-00
—
NE
05
—
1586982
—
IA
05
—
2586982
—
IA
05
—
3586982
—
IA
Enumeration date
01/15/2007
Last updated
11/22/2010
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