Healthcare Provider Details

I. General information

NPI: 1821080243
Provider Name (Legal Business Name): JEFFREY E MOLTER C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MEDICAL BLVD
FINDLAY OH
45840-1398
US

IV. Provider business mailing address

10335 PINECREST RD
CONCORD TWP OH
44077-8814
US

V. Phone/Fax

Practice location:
  • Phone: 419-429-0409
  • Fax: 419-429-0410
Mailing address:
  • Phone: 440-478-8448
  • Fax: 440-478-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number248071
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: