Provider Demographics
NPI:1154132637
Name:MOELLER, CONNOR
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:MOELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6148 S 94TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9629
Mailing Address - Country:US
Mailing Address - Phone:531-333-0205
Mailing Address - Fax:
Practice Address - Street 1:8233 SUNRIDGE CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2727
Practice Address - Country:US
Practice Address - Phone:402-489-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider