Healthcare Provider Details

I. General information

NPI: 1760849657
Provider Name (Legal Business Name): MOLLY ANN NOWILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST STE 501A
MURRAY UT
84107-6767
US

IV. Provider business mailing address

351 HILLSIDE RD
WESTFIELD MA
01085-4109
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3513
  • Fax: 801-507-3584
Mailing address:
  • Phone: 413-374-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: