Healthcare Provider Details

I. General information

NPI: 1558358002
Provider Name (Legal Business Name): MOLLY MACDONALD MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST FLOOR WOOD BUILDING, CHOP ENT 34TH AND CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4405 PINE ST
PHILADELPHIA PA
19104-3921
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP007665
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN531128
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR12209600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: