Healthcare Provider Details

I. General information

NPI: 1780044131
Provider Name (Legal Business Name): MOLLY MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 N OAKLAND BLVD
WATERFORD MI
48327-1545
US

IV. Provider business mailing address

PO BOX 430150
PONTIAC MI
48343-0150
US

V. Phone/Fax

Practice location:
  • Phone: 248-599-8999
  • Fax:
Mailing address:
  • Phone: 248-724-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704242334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: