MEDICARE: MOLLY PAGE LASHLEY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2019032537	MO

General Provider Information

NPI Number	:	1417504358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY PAGE LASHLEY FNP-BC

Provider Business Mailing Address
First Line	:	329 HIGH POINT DR
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-5227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 HIGH POINT DR
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-5227
Country	:	US
Telephone Number	:	618-977-6797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	05/05/2021

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