Healthcare Provider Details

I. General information

NPI: 1326611690
Provider Name (Legal Business Name): MOLLY YOUNG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17571 N DAM ACCESS RD
WARSAW MO
65355-6396
US

IV. Provider business mailing address

17571 N DAM ACCESS RD
WARSAW MO
65355-6396
US

V. Phone/Fax

Practice location:
  • Phone: 660-428-1280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2017000412
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: