Healthcare Provider Details

I. General information

NPI: 1336979434
Provider Name (Legal Business Name): MOLLY NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAHONING AVE
WARREN OH
44483
US

IV. Provider business mailing address

4332 AARON RD
ERIE PA
16511-1311
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-6244
  • Fax:
Mailing address:
  • Phone: 814-812-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2607668-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: