Healthcare Provider Details

I. General information

NPI: 1417030305
Provider Name (Legal Business Name): PATRICIA THELMA MOLLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMHCS, PERRY POINT DIVISION BUILDING 366, ROOM 140
PERRY POINT MD
21902
US

IV. Provider business mailing address

425 FLINTVILLE RD
DELTA PA
17314-8537
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-1003
  • Fax: 410-642-2411
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberLE-0000138
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: