Healthcare Provider Details

I. General information

NPI: 1659746501
Provider Name (Legal Business Name): MOLLY ANN IHLENDORF CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

IV. Provider business mailing address

3333 BURNET AVE # MLC7015
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-659-2379
  • Fax:
Mailing address:
  • Phone: 513-636-4266
  • Fax: 513-636-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020848
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020848
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.362495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: