Healthcare Provider Details

I. General information

NPI: 1982666186
Provider Name (Legal Business Name): MOLLY TRIPP GRAYBEAL WNHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 S MADISON ST
MUNCIE IN
47302-5756
US

IV. Provider business mailing address

3715 S MADISON ST PO BOX 1676
MUNCIE IN
47302-5756
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-7000
  • Fax: 765-213-2769
Mailing address:
  • Phone: 765-286-7000
  • Fax: 765-213-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71002765A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: