Healthcare Provider Details

I. General information

NPI: 1871677278
Provider Name (Legal Business Name): MOLLY J BAUR ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY J GREGORY ACNP-BC

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE GLEN OAK AVE
PEORIA IL
61636-1000
US

IV. Provider business mailing address

8081 ROYAL RIDGE PKWY STE 120
IRVING TX
75063-2840
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209-004546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: