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General NPI Number Information
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NPI Number | 1538795604
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Entity Type | Individual
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Provider Name | MOLLY ELLIOTT MEADOWS GRUNDY ACCNS
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Gender | Female
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 1701 S CREASY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-4972
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Country | US
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Telephone | 765-428-3448
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W MAIN ST
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-1626
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Country | US
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Telephone | 765-918-1154
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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 | 364SC0200X
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Taxonomy Name | Critical Care Medicine Clinical Nurse Specialist
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License Number | 28187462A
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License Number State | IN
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