Healthcare Provider Details

I. General information

NPI: 1619568219
Provider Name (Legal Business Name): MOLLY ELIZABETH YAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY ELIZABETH HOLWAY FNP

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1377 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-8470
  • Fax: 503-769-9860
Mailing address:
  • Phone: 503-769-8470
  • Fax: 503-769-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201810173RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202100649NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: