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Individual

LISA MOELLERING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, CPNP-PC

Contact information

Practice address
3919 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6811
(832) 482-8518
Mailing address
3919 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6811
(260) 436-7722
(260) 459-0012

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
28144452A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1275546913
IN
Enumeration date
03/10/2016
Last updated
04/25/2025
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