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General NPI Number Information
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NPI Number | 1063835841
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Entity Type | Individual
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Provider Name | MOLLY MAHAN LMP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 430 E LAURIDSEN BLVD STE 113
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City | PORT ANGELES
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State | WA
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Zip | 98362-7978
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Country | US
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Telephone | 360-457-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 E 3RD ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-4402
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Country | US
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Telephone | 360-774-6184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | MA60437812
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License Number State | WA
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