Doctor Name: | MISS SARA ANN MOELLER |
NPI Number: | 1043565328 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 002295 |
Business Practice Address: | 804 Kenyon Rd Suite M Fort Dodge, IA - 505015742 |
Business Phone Number: | 5155746850 |
Business Fax Number: | 5155764510 |
Mailing Address: | 802 Kenyon Rd, 513 FORT DODGE |
State: | IA |
Postal Code: | 505015740 |
Phone Number: | 5155746850 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2012 |
NPI Last Update Date: | 08/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 002295 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |