MEDICARE: MOLLY LYN ANDERSON WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	209015302	IL
2	363L00000X	Nurse Practitioner	15565	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154866374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LYN ANDERSON WHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 SPRING CITY DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-5934
Country	:	US
Telephone Number	:	262-301-2020
Fax Number	:

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

Provider Enumeration Date	:	12/24/2016
Last Update Date	:	11/25/2024

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