Healthcare Provider Details

I. General information

NPI: 1295390730
Provider Name (Legal Business Name): MOLLY NIDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD STE 111
ANKENY IA
50023-9417
US

IV. Provider business mailing address

1429 NE POPLAR CT
GRIMES IA
50111-2357
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax:
Mailing address:
  • Phone: 641-680-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number118243
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL98
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: