MEDICARE: MS. SONNJA MICHELLE MOLTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HC1222	OTHER	OH	OHIO CHOICE DEMONSTRATION PROGRAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003056565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONNJA MICHELLE MOLTON

Provider Business Mailing Address
First Line	:	944 E 147TH ST
Second Line	:	APARTMENT 1
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3732
Country	:	US
Telephone Number	:	216-970-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	944 E 147TH ST
Second Line	:	APARTMENT 1
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3732
Country	:	US
Telephone Number	:	216-970-6879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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