Healthcare Provider Details

I. General information

NPI: 1811465388
Provider Name (Legal Business Name): MARY MOLLE RN, CNS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 HACIENDA CARMEL
CARMEL CA
93923-7946
US

IV. Provider business mailing address

7509 WHITEGATE AVE
RIVERSIDE CA
92506-5455
US

V. Phone/Fax

Practice location:
  • Phone: 831-625-7669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: