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General NPI Number Information
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NPI Number | 1154310902
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Entity Type | Individual
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Provider Name | MOLLY ANNE MOORE-PULLIN A.N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 802 AINSWORTH DR STE A
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City | PRESCOTT
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State | AZ
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Zip | 86301-1623
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Country | US
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Telephone | 928-445-6025
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Fax | 928-777-2423
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 928-759-5874
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Fax | 928-458-2039
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN049339
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License Number State | AZ
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