Healthcare Provider Details

I. General information

NPI: 1023593274
Provider Name (Legal Business Name): MOLLIE ROVNAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLIE ROGERS

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 N BROAD ST
LANSDALE PA
19446-1002
US

IV. Provider business mailing address

1970 N BROAD ST
LANSDALE PA
19446-1002
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-1900
  • Fax: 215-368-8772
Mailing address:
  • Phone: 215-368-1900
  • Fax: 215-368-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019173
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: