Healthcare Provider Details

I. General information

NPI: 1093489353
Provider Name (Legal Business Name): MOLLY MAHAY DNP,AC-P APRN,CPHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

111 W MAPLE ST APT 1704
CHICAGO IL
60610-5449
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-1700
  • Fax:
Mailing address:
  • Phone: 614-581-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-023682
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-023682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: