Healthcare Provider Details

I. General information

NPI: 1790192243
Provider Name (Legal Business Name): MOLLY SCARBOROUGH MCMILLION RN, BSN, IBCLC, CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CIRCLE DR
LEWISBURG WV
24901-8952
US

IV. Provider business mailing address

107 CIRCLE DR
LEWISBURG WV
24901-8952
US

V. Phone/Fax

Practice location:
  • Phone: 304-667-4362
  • Fax:
Mailing address:
  • Phone: 304-667-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number61869
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: