=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326042094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY BARTLETT CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 RIDGELY AVE STE 130
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-266-8049
-----------------------------------------------------
Fax | 410-266-0787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 RIDGELY AVE STE 130
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-266-8049
-----------------------------------------------------
Fax | 410-266-0787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | R086942
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------