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General NPI Number Information
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NPI Number | 1992316905
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Entity Type | Individual
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Provider Name | MOLLY LOUISE MCINNIS NP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 1015 S WASHINGTON AVE FL 3
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City | SAGINAW
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State | MI
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Zip | 48601-2556
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Country | US
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Telephone | 989-907-8716
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Fax |
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Provider Business Mailing Address
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Address Line | 11096 LADUKE RD
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City | FREELAND
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State | MI
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Zip | 48623-9010
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Country | US
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Telephone | 989-798-2360
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704314318
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License Number State | MI
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