Healthcare Provider Details

I. General information

NPI: 1992582415
Provider Name (Legal Business Name): MOLLY DORAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY GOTSCHALL

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 S 27TH ST STE 201
LINCOLN NE
68512-4872
US

IV. Provider business mailing address

6825 S 27TH ST STE 201
LINCOLN NE
68512-4872
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-5235
  • Fax:
Mailing address:
  • Phone: 402-434-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: