Healthcare Provider Details

I. General information

NPI: 1760297766
Provider Name (Legal Business Name): MOLLY PARKER LM, CPM, BSM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W SAN JOSE AVE APT 105
FRESNO CA
93704-2736
US

IV. Provider business mailing address

140 W SAN JOSE AVE APT 105
FRESNO CA
93704-2736
US

V. Phone/Fax

Practice location:
  • Phone: 559-776-2757
  • Fax:
Mailing address:
  • Phone: 559-776-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: