Healthcare Provider Details

I. General information

NPI: 1700347176
Provider Name (Legal Business Name): MOLLY JANE HOHMAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 S EASTERN AVE STE 120-G
LAS VEGAS NV
89123-4891
US

IV. Provider business mailing address

4029 DEAN MARTIN DR
LAS VEGAS NV
89103-4138
US

V. Phone/Fax

Practice location:
  • Phone: 702-913-5498
  • Fax:
Mailing address:
  • Phone: 702-848-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8227-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: