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General NPI Number Information
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NPI Number | 1013180173
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Entity Type | Organization
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Legal Business Name | MOLLY HENDERSON ARNP INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 1005 OLYMPIA AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4033
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Country | US
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Telephone | 360-791-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 OLYMPIA AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4033
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Country | US
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Telephone | 360-791-5933
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARTHA HENDERSON
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Credential | ARNP
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Telephone | 360-791-5933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | AP30006528
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License Number State | WA
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