Provider Demographics
NPI:1902967755
Name:MOELLER, DEBBIEANNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIEANNE
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CASTLE VALLEY BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9480
Mailing Address - Country:US
Mailing Address - Phone:970-984-3333
Mailing Address - Fax:970-984-0293
Practice Address - Street 1:820 CASTLE VALLEY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9480
Practice Address - Country:US
Practice Address - Phone:970-984-3333
Practice Address - Fax:970-984-0293
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83645363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42200547Medicaid