Healthcare Provider Details

I. General information

NPI: 1326042094
Provider Name (Legal Business Name): MOLLY BARTLETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

IV. Provider business mailing address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax: 410-266-0787
Mailing address:
  • Phone: 410-266-8049
  • Fax: 410-266-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR086942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: