Healthcare Provider Details

I. General information

NPI: 1215987318
Provider Name (Legal Business Name): NELLY MOLANO C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 DENISE DR APT E
FOREST HILL MD
21050-2989
US

IV. Provider business mailing address

1622 DENISE DR APT E
FOREST HILL MD
21050-2989
US

V. Phone/Fax

Practice location:
  • Phone: 410-733-3607
  • Fax:
Mailing address:
  • Phone: 410-733-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number339007
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR140445
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR140445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: