Healthcare Provider Details

I. General information

NPI: 1073952495
Provider Name (Legal Business Name): MARIA C MOLTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA C. LILLY

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5177 MCCARTY LN
LAFAYETTE IN
47905-8764
US

IV. Provider business mailing address

1200 W WHITE RIVER BLVD STE 201
MUNCIE IN
47303-4988
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-8000
  • Fax: 765-838-6302
Mailing address:
  • Phone: 877-668-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71004729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: