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General NPI Number Information
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NPI Number | 1184202111
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Entity Type | Individual
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Provider Name | MOLLY ELINOR STORM
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | N64W25037 PROSPECT CIR
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City | SUSSEX
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State | WI
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Zip | 53089-2680
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Country | US
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Telephone | 262-532-8680
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Fax |
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Provider Business Mailing Address
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Address Line | W180N8000 TOWN HALL RD
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-4002
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 81316-21
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License Number State | WI
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